Immune thrombocytopenia

• Article
• 2021-02-03

Immune thrombocytopenia (THROM-bo-si-toe-PE-ne-ah), or ITP, is a bleeding disorder. With ITP, the blood does not clot as it should. This is due to a low number of blood cell fragments called platelets (PLATE-lets) or thrombocytes (THROM-bo sites).

Platelets are made in your bone marrow along with other types of blood cells. They stick together (clot) to seal small cuts or breaks on the walls of blood vessels and stop bleeding.

Without enough platelets, bleeding can occur in the body (internal bleeding) or under or from the skin (external bleeding).

People with ITP often have purple bruises called purpura (PURR-purr-ah). These bruises appear on the skin or mucous membranes (for example, in the mouth). Bleeding from small blood vessels under the skin causes purpura.

People with ITP can also have bleeding that causes tiny red or purple dots on the skin. These pointed dots are called petechiae (peh-TEE-kee-ay). Petechiae can look like a rash.

Petechiae and Purpura

People with ITP may also have nosebleeds, bleeding gums during dental work, or other bleeding that is difficult to stop. Women with ITP may have menstrual bleeding that is heavier than normal.

Many bleeding can cause hematomas (he-mah-TO-mas). A hematoma is a collection of clotted or partially clotted blood under the skin. It looks or feels like a lump.

Bleeding in the brain due to ITP is very rare, but can be life-threatening if they occur.

In most cases, an autoimmune response is thought to trigger ITP. Normally, your immune system helps your body fight infection and disease. But when you have ITP, your immune system attacks and destroys its own platelets. The reason why this happens is not known.

ITP cannot be transferred from one person to another.

Types of immune thrombocytopenia

The two types of ITP are acute (temporary or short-term) and chronic (long-term).

Acute ITP generally lasts less than 6 months. It mainly occurs in children - both boys and girls - and is the most common type of ITP. Acute ITP often occurs after a viral infection.

Chronic ITP lasts 6 months or more and mainly affects adults. However, some teens and children do get this type of ITP. Chronic ITP affects women two to three times more often than men.

Treatment depends on the severity of the bleeding and the platelet count. In mild cases, treatment may not be necessary.

Symptoms

Immune thrombocytopenia (ITP) should not cause any signs or symptoms. However, ITP can cause bleeding in the body (internal bleeding) or under or out of the skin (external bleeding). Signs of bleeding can include:

• Bruising or purplish patches on the skin or mucous membranes (such as in the mouth). These bruises are called purpura. They are caused by bleeding under the skin and can occur for no known reason.
• Locate red spots on the skin called petechiae. These spots are often found in groups and may resemble a rash. Bleeding under the skin causes petechiae.
• A collection of clotted or partially clotted blood under the skin that looks or feels like a lump. This is called a hematoma.
• Nosebleeds or bleeding gums (for example, during dental work).
• Blood in the urine or stools (stools).

Any kind of bleeding that is difficult to stop can be a sign of ITP. This includes menstrual bleeding that is heavier than normal. Bleeding in the brain is rare and symptoms can vary.

A low platelet count does not immediately cause pain, difficulty concentrating or other symptoms. However, a low platelet count can be associated with tiredness (tiredness).

Therapy

The treatment for immune thrombocytopenia (ITP) is based on how much and how often you bleed and your platelet count.

Adults with mild ITP may not need any treatment other than watching their symptoms and platelet counts. Adults with ITP with very low platelet counts or bleeding problems are often treateddeld.

The acute (short-term) type of ITP that occurs in children often resolves within weeks or months. Children with bleeding symptoms, other than just bruises (purpura), are usually treated.

Children with mild ITP may not need treatment other than monitoring and follow-up to ensure their platelet count returns to normal.

Medicines

Medicines are often used as the first course of treatment for both children and adults.

Corticosteroids (cor-ti-co-STEER roids), such as prednisone, are often used to treat ITP. These drugs, called steroids for short, help increase the platelet count. However, steroids have many side effects. Some people relapse (get worse) when treatment stops.

The steroids used to treat ITP are different from the illegal steroids some athletes use to boost their performance. Corticosteroids are not addictive, even if you use them for years.

Other medicines are also used to increase the platelet count. Some are given through a needle inserted into a vein. These drugs include rituximab, immunoglobulin and anti-Rh (D) immunoglobulin.

Medicines can also be used in a procedure to remove the spleen called a splenectomy (splee-NECK-tuh-mee).

If drugs or splenectomy don't help, two newer drugs - eltrombopag and romiplostim - can be used to treat ITP.

Removal of the spleen (splenectomy)

If necessary, doctors can surgically remove the spleen. This organ is located in the top left of the abdomen. The spleen is about the size of a golf ball in children and a baseball in adults.

The spleen makes antibodies (proteins) that help fight infections. In ITP, these antibodies accidentally destroy platelets.

If ITP has not responded to medications, removing the spleen will reduce platelet destruction. However, it can also increase your risk of infections. Before you have the surgery, your doctor can give you vaccines to help prevent infections.

Once your spleen has been removed, your doctor will explain steps you can take to prevent infections and the symptoms to look out for.

Other treatments

Platelet transfusions

Some people with ITP with severe bleeding may need platelet transfusions and need to be hospitalized. Some people need platelet transfusions before having surgery.

For a platelet transfusion, donor platelets from a blood bank are injected into the recipient's bloodstream. This increases the platelet count for a short time.

For more information on platelet transfusions, please visit the Health Topics Blood Transfusion article.

Treat infections

Some infections can temporarily lower your platelet count. By treating the infection, you can increase your platelet count and reduce bleeding problems.

Stop medications

Some medicines can lower blood platelets or cause bleeding. Stopping the medicine can sometimes help increase platelet count or prevent bleeding.

For example, aspirin and ibuprofen are common drugs that increase the risk of bleeding. If you have ITP, your doctor may recommend that you avoid these medications.

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