Immune Thrombocytopenia Purpura
(Idiopathic Thrombocytopenic Purpura; ITP)
Immune thrombocytopenia purpura (ITP) is a bleeding disorder. It is a drop in the number of platelets in your blood. Platelets are small cells that stick together to form blood clots. These clots help stop bleeding at injury sites. ITP causes bruising or bleeding even with minor injuries.
There are 2 types:
- Primary—no known cause
- Secondary—caused by an underlying condition or medicines
Problems with the immune system cause ITP. The body attacks healthy tissue. In this case, platelet cells are removed from the bloodstream. They are destroyed by the spleen and liver. Over time, there is a drop in healthy cells. The drop can be severe enough to cause problems with blood’s ability to clot.
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For most ITP, it is not clear what causes these problems. In children, ITP is often related to a recent viral infection. ITP in adults has not been linked to viruses.
Sometimes, certain medicines cause ITP or other problems with the immune system.
The chances of ITP are higher for:
- Women—mainly those under 40 years old
- Children—history of a viral infection or vaccine with a live virus
ITP may cause:
- Easy bruising
- Blood in the urine or stool
- Bleeding for longer than normal
- Unexplained nosebleeds
- Bleeding from the gums
- In adult women, heavier bleeding during a period
- Red dots on the skin—may happen in groups and look like a rash
- Bleeding within the intestines or brain—rare
The doctor will ask about your symptoms and health history. You may have:
- A physical exam
- Blood tests
- Bone marrow tests
Care for ITP is different for children and adults. ITP is short term in most children. Most children will improve on their own. Adults are more likely to have a long lasting form of ITP. Not all forms need care.
Care may involve:
The goal is to have platelet numbers in a certain range. Your doctor may advise:
- Steroids to ease the effects of the immune system on platelet destruction
- Gamma globulin infusions—slow the pace of platelet destruction
Your doctor will advise you of what side effects may happen with this care.
Medicine may also be given to help your body make more platelets. These may prevent the need for surgery.
A platelet transfusion will help keep the platelet level from dropping too low.
If medicines don’t work, your spleen may be removed. Without your spleen, your platelet levels should start to get better. Your chances of certain infections are higher without a spleen.
You may have to restrict certain activities during times when your platelet levels are low. This may include contact sports. You should take steps to protect yourself such as wearing protective sports gear.
There is no way to prevent ITP since the cause is unknown.
Family Doctor—American Academy of Family Physicians
National Heart, Lung, and Blood Institute
Caring for Kids—Canadian Paediatric Society
Immune thrombocytopenia. National Heart Lung and Blood Institute website. Available at: https://www.nhlbi.nih.gov/health-topics/immune-thrombocytopenia. Accessed November 20, 2019.
Immune thrombocytopenia (ITP) in adults. EBSCO DynaMed website. Available at:https://www.dynamed.com/condition/immune-thrombocytopenia-itp-in-adults. Updated March 19, 2019. Accessed November 20, 2019.
Immune thrombocytopenic purpura. Johns Hopkins Medicine website. Available at: https://www.hopkinsmedicine.org/healthlibrary/conditions/adult/hematology_and_blood_disorders/idiopathic_thrombocytopenic_purpura_85,P00096. Accessed November 20, 2019.
Last reviewed November 2019 by EBSCO Medical Review Board Michael Fucci, DO, FACC