ITP

What is immune thrombocytopenia?

 — Immune thrombocytopenia (ITP) is a bleeding disorder. People with ITP can bruise or bleed much more easily than normal.

ITP causes low platelets. Platelets are cells that are normally found in the blood that help blood to clot. People with ITP have fewer platelets than normal. That’s because their immune system destroys their platelets. The immune system is the body’s infection-fighting system.

Both adults and children can get ITP, but ITP is more common in children. Children who get ITP usually get it after they have an infection. Doctors do not always know why adults get ITP.

What are the symptoms of ITP? — Some people with ITP have no symptoms. When people do have symptoms, they can:

●Bleed easily – This can include nosebleeds or blood-filled blisters inside the mouth. Women with ITP can bleed more than usual during their monthly periods.

●Bruise easily – This could look like large bruises or tiny bruise-like dots on the feet and ankles.

In children, symptoms usually start suddenly. In adults, symptoms can start slowly or suddenly.

Is there a test for ITP? — Yes and no. There is no test that can tell for sure if a person has ITP. But doctors can do blood tests to see if a person has fewer than normal platelets. This test is called a “complete blood count (CBC).” One part of the CBC measures the number of platelets in the body. This is called the “platelet count.”

If a blood test shows that a person has fewer platelets than normal, the doctor will do an exam and ask about symptoms. This is to figure out if the low platelets are caused by ITP or another condition. In children, ITP is the most common cause of low platelets, and other tests might not be needed. In adults, sometimes other tests are needed. For example, doctors sometimes do a test called a bone marrow biopsy. The bone marrow is the tissue inside your bones. It makes all of the blood cells and platelets. During a bone marrow biopsy, a doctor takes a tiny sample of bone marrow. Then another doctor looks at the sample under a microscope.

How is ITP treated? — Treatment for ITP depends on the person’s age, symptoms, and how low the platelets are.

Children with ITP do not need treatment unless they have a lot of bleeding or have very low platelet counts. For most children, ITP goes away on its own within 6 months. But doctors follow children with ITP closely to make sure the ITP does not get worse or end up needing treatment.

Adults with mild ITP do not usually need treatment. But adults with very low platelet counts or bleeding will most likely need treatment.

●Adults who need treatment are first treated with medicines called steroids. (These medicines are different from the steroids athletes take to build muscle.) Even though steroids can help treat ITP, they can also cause problems of their own. The doctor will talk to you about the possible side effects of steroids. If the ITP doesn’t get better with steroids, doctors can use other treatments. These include:

•A medicine called “intravenous immunoglobulin” (IVIG) – This medicine helps the body’s immune system. Children who need treatment for their ITP are treated with IVIG before they are treated with steroids.

•Surgery to remove the spleen – The spleen is an organ in the body’s immune system that destroys platelets in ITP (figure 1).

•Medicines that can help the body make more platelets

If these treatments don’t work, other treatments are available.

What else might people with ITP need to do? — Depending on their platelet count and symptoms, people with ITP might need to:

●Avoid certain sports or activities – It’s very important for children to limit their physical activity and not play certain sports, especially contact sports. That’s because children can get hurt by accident. If a person with a very low platelet count gets hurt, he or she can bleed a lot. The doctor will tell you which activities and sports your child should avoid. Adults might also need to limit their activities and sports. People can do their usual sports and activities again when their ITP gets better.

●Avoid taking certain medicines – Some medicines, such as aspirin, affect blood clotting. Your doctor will let you know which prescription and over-the-counter medicines to avoid.

What if I have ITP and want to get pregnant? — If you have ITP and want to get pregnant, talk with your doctor or nurse. Most women with ITP have a normal pregnancy and delivery.

There is a very small chance that your baby will have a low platelet count after he or she is born. A doctor will decide if the baby’s blood needs to be tested. This usually gets better on its own.