Immune Thrombocytopenia (ITP) Symptoms and Treatment

Platelets in circulation
Platelets in circulation. Science Photo Library - SCIEPRO/Brand X Pictures/Getty Images

 Definition 

Immune thrombocytopenia (ITP),  formerly called idiopathic thrombocytopenic purpura, is a condition where your body’s immune system attacks and destroys your platelets causing low platelet counts (thrombocytopenia) which may result in bleeding.   

Symptoms of ITP

Symptoms of ITP are related to the low platelet count and may include: 

  • Nosebleeds 

  • Gum bleeding 

  • Blood in urine or stool 

  • Excessive menstrual bleeding known as menorrhagia

  • A rash of small red dots on the skin known as petechiae. 

  • Easy bruising.  The bruises may be large and raised.  

  • Blood blisters in the mouth known as wet purpura   

Causes of ITP 

ITP is a result of antibodies that attach to the platelets.  The spleen recognizes these antibodies and destroys the platelets.  Sometimes doctors are unable to find a cause for the ITP.  

  • Viruses:  In children, ITP is often triggered by a viral infection.  The viral infection usually occurs a couple of weeks prior to the symptoms.   

  • Immunizations:  ITP has been associated with the administration of the MMR (measles, mumps, rubella) vaccine.  It is important to note that this risk is small and you are much more likely to develop ITP if you contract measles than receiving the vaccine. 

  • Autoimmune disease:  ITP is considered an autoimmune disorder and maybe the presentation of a large autoimmune disease like lupus or rheumatoid arthritis. 

    Diagnosis of ITP

    Similar to other blood disorders like anemia and neutropenia, ITP is identified on a complete blood count (CBC).  There is no one diagnostic test for ITP.  It is a diagnosis of exclusion, meaning other causes have been ruled out.  In general, only the platelet count is decreased in ITP; the white blood cell count and hemoglobin are normal.

     Your health care provider may have the platelets examined under a microscope (called a peripheral blood smear) to ensure that the platelets are decreased in number but appear normal.  In the midst of the workup, you may have other testing to rule out cancer or other reasons for a low platelet count.  If your ITP is thought to be secondary to an autoimmune disease, you may have to test specifically for this.  

    Treatment of ITP 

    Currently, the treatment of ITP is dependent on the presence of bleeding symptoms rather than a specific platelet count.   The goal of therapy is to stop bleeding or to bring the platelet count up to a "safe" range.  Although technically not a "treatment", people with ITP should avoid taking aspirin or ibuprofen-containing medications as these decrease the function of platelets.  

    • Observation:  If you are not having any bleeding symptoms currently, your physician may choose to watch you closely without giving medications. 

    • Steroids:  Steroids like methylprednisolone or prednisone are the most common medication used to treat ITP worldwide.   Steroids reduce the destruction of platelets in the spleen.  Steroids can be very effective but may take more than a week to increase your platelet count.  

    • IVIG: Intravenous immune globulin (IVIG) is a common treatment for lTP.  It is generally used for patients with bleeding who need a rapid rise in the platelet count.  It is administered as an IV infusion over several hours.  

    • WinRho: WinRho is a rho (D) immune globulin that can be used in people with certain blood types.  It is a faster infusion than IVIG.  

    If your ITP persists and does not respond to initial treatments you doctor may recommend other treatments such as:  

    • Splenectomy:  In ITP the platelets are destroyed in the spleen.  By removing the spleen, the  life expectancy of the platelets can be increased.  

    • Rituximab:  Rituximab is a medication called a monoclonal antibody.  This medication helps to destroy the white blood cells that produce the antibodies against platelets, called B-cells.  The hope is that when your B-cells regenerate, they will no longer make the anti-platelet antibody. 

    • Thrombopoietin agonists: Some of the newest treatments are thrombopoietin (TPO) agonists.  These medications eltrombopag (oral) or romiplostim (subcutaneous) stimulate your bone marrow to make more platelets. 

     The differences in children and adults 

     It is important to note that the natural history of ITP is often different in children versus adults.   In children, ITP is often transient and resolves completely.  In adults, ITP is much more likely to become chronic in nature.  

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