What Is ITP?
Idiopathic thrombocytopenic purpura (ITP) is a disorder in
which the blood doesn’t clot normally. This can cause excessive bruising and
bleeding. An unusually low level of platelets, or “thrombocytes,” in the blood,
causes ITP. ITP is also called immune thrombocytopenic purpura.
Platelets are produced in the bone marrow. They help stop
bleeding by clumping together to form a clot that seals cuts or small tears in
blood vessel walls. If your blood doesn’t have enough platelets, it’s slow to
clot. Internal bleeding or bleeding on or under the skin can result.
People with ITP often have many purple bruises
called purpura on the skin or mucous membranes inside the mouth.
These bruises may also appear as pinpoint-sized red or purple dots on the skin
called petechiae. Petechiae may look like a rash.
ITP can occur in both children and adults. According to the Mayo Clinic, it’s more common in women than men.
Children are more likely to develop this condition after a viral illness, such
as the mumps or measles.
Types of ITP
The two types of ITP are acute (short-term) and chronic
Acute ITP is the most common form of the disorder. It usually
lasts less than six months and mainly occurs in children.
Chronic ITP lasts six months or longer. It’s most commonly
seen in adults, although teenagers and younger children can be affected.
What Causes ITP?
The word “idiopathic” means “of unknown cause.” This means the exact
cause of ITP hasn’t been identified. However, it’s generally believed that most
cases of ITP are triggered by an autoimmune response that causes the immune
system to view platelets as foreign bodies instead of the person’s own cells.
In response, the immune system produces antibodies that mark platelets for
destruction and removal by the spleen, which lowers the platelet count.
In children, ITP most commonly follows a virus, such as the flu,
measles, or mumps. In adults, ITP can occasionally occur after a viral
infection, but it’s more commonly triggered by an immune disorder, pregnancy,
or the use of certain drugs.
ITP isn’t contagious and cannot be passed from one person to
What Are the Symptoms of ITP?
The most common symptoms of ITP are:
- bruising easily
- pinpoint-sized petechiae, often on the lower
- spontaneous nosebleeds
- bleeding from the gums (for example, during
- blood in the urine
- blood in the stool
- abnormally heavy menstruation
- prolonged bleeding from cuts
- profuse bleeding during surgery
Some people with ITP have no symptoms.
How Is ITP Diagnosed?
Your doctor will perform a complete physical exam. They’ll ask
you about your medical history and the medications you’re taking.
Your doctor will also order a blood test that includes
a complete blood count. The blood test may also include a test to
determine if your blood contains platelet antibodies.
Your doctor may also perform a blood smear, in
which some of your blood is placed on a glass slide and viewed under a
microscope to verify the number of platelets seen in the complete blood count.
If you have a low platelet count, your doctor may also order a bone
marrow test. If you have ITP, your bone marrow will be normal. This
is because your platelets are destroyed in the bloodstream and spleen after
they leave the bone marrow. If your bone marrow is abnormal, your low platelet count
will likely be caused by another disease, not ITP.
What Are the Treatments for ITP?
Your doctor will choose your treatment based on the total number
of platelets you have and on how often and how much you bleed. In some cases,
treatment isn’t needed. For example, children that develop the acute form of
ITP usually recover within six months without any treatment.
Adults with less severe cases of ITP may also not require
treatment. However, your doctor will still want to monitor your platelet count
to make sure you don’t need treatment in the future.
If you or your child requires treatment, your doctor will likely
prescribe medications as the first course of treatment. The most common
medications used to treat ITP include:
Your doctor may prescribe a corticosteroid, such as prednisone, which can increase your platelet count
by decreasing the activity of your immune system.
Intravenous Immune Globulin (IVIG)
If your bleeding has reached a critical level or you are going
to have surgery and need to increase your platelet count quickly, you may be
given intravenous immune globulin (IVIG).
Thrombopoietin Receptor Agonists
Thrombopoietin receptor agonists, including romiplostim and
eltrombopag, help prevent bruising and bleeding by causing your bone marrow to
produce more platelets.
If these medications don’t improve your symptoms, your doctor
may choose to prescribe other drugs, including:
Immunosuppressants inhibit the activity of the immune system.
However, they have significant side effects.
New medications that increase platelet production are being
studied in clinical trials. Two of these, eltrombopag and AMG 531, appear to be
well-tolerated. However, studies are continuing to determine whether they are
safe and effective.
Some people with ITP are also infected with Helicobacter pylori,
which is the same bacteria that causes most peptic ulcers. Antibiotic therapy
to eliminate H. pylori has helped increase platelet counts in
If you have severe ITP and medication doesn’t improve your
symptoms or platelet count, your doctor may advise surgery to remove your spleen.
This is called a splenectomy. Your spleen is located in your upper left
Splenectomy isn’t usually performed in children because of the high
rate of spontaneous remission, or unexpected improvement.
Severe or widespread ITP requires emergency treatment. This
usually includes transfusions of concentrated platelets and intravenous
administration of a corticosteroid such as methylprednisolone,
IVIG, or both.
Your doctor may also advise you to make some lifestyle changes,
including the following:
- Avoid certain over-the-counter drugs that can
affect platelet function, including aspirin, ibuprofen (Advil, Motrin), and the
blood-thinning medication warfarin
- Limit your intake of alcohol because consuming
too much alcohol can adversely affect blood clotting.
- Choose low-impact activities instead of
competitive sports or other high-impact activities to decrease your risk of
injury and bleeding.
Treatment for ITP During Pregnancy
Treatment for pregnant women with ITP depends on the platelet
count. If you have a mild case of ITP, you probably won’t need any treatment
other than careful monitoring and regular blood tests.
If you have an extremely low platelet count or excessive
bleeding, you’re more likely to experience serious, heavy bleeding during and
after delivery. In these cases, your doctor will work with you to determine a
treatment plan that will help maintain a safe platelet count without adversely
affecting your baby.
Although most babies born to mothers with ITP aren’t affected by
the disorder, some are born with or develop a low platelet count soon after
birth. In most cases, the platelet count will return to normal without any
treatment. Treatment may be necessary for babies with very low platelet counts.
What Are the Possible Complications of ITP?
The most dangerous complication of ITP is bleeding, especially
bleeding into the brain, which can be fatal. However, serious bleeding is rare.
The treatments for ITP can have more risks than the disease
itself. The long-term use of corticosteroids can cause serious side effects,
- a loss of muscle mass
- an increased risk of infection
- high blood sugar
Surgery to remove the spleen permanently increases your risk of
infection and the risk of becoming ill if you get an infection. It’s important
to watch for any symptoms of infection and report them to your doctor promptly.
What Is the Outlook for ITP?
In the majority of people with ITP, the condition isn’t serious
Acute ITP in children often resolves within six months without
Chronic ITP can last for many years. People can live for many
decades with the disease, even those with severe cases. Many people with ITP are
eventually able to discontinue treatment safely.