Chronic ITP

Immune Thrombocytopenic Purpura

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.
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.
Sometimes, there can be more serious bleeding, like bleeding in the brain or inside the body.
Is there a test for ITP? — Yes and no. There is a test for the number of platelets in the blood, called the "platelet count." This is often done as part of a "complete blood count" (or "CBC"). If your platelet count is low, ITP might be the cause. But there is no test that can tell for sure if the low platelet count is because of ITP or something else.
If a blood test shows that a person has a low platelet count, the doctor will ask about symptoms, do an exam, and do some blood tests. This is to help figure out if another condition is causing the low platelet count. The main test is called the "complete blood count." It tells if other blood cell counts are also low, or only the platelet count.
In children, ITP is the most common cause of a low platelet count. In adults, there are other possible causes, and sometimes other tests are needed. For example, doctors sometimes do a test called a bone marrow biopsy. The bone marrow is the cells inside your bones. It makes all of the blood cells and platelets. A bone marrow biopsy is a procedure that involves using a needle to take a tiny sample of bone marrow from one of the hip bones. Then the sample is examined under a microscope.
If another cause for a low platelet count can't be found, the person is usually said to have ITP.
How is ITP treated? — Treatment for ITP depends on the person's age, symptoms, and how low the platelet count is.
Children with ITP do not need treatment unless they have a lot of bleeding or have a very low platelet count. 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 a very low platelet count or bleeding will most likely need treatment. But if the ITP is mild, treatment is usually not needed.
Adults who need treatment are first treated with medicines called steroids. (These are not the same as the steroids some athletes take illegally.) Steroids stop the body's immune system from destroying platelets. 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. For people who need a very fast increase in platelet count, a medicine called intravenous immune globulin (or "IVIG") can be used. This medicine stops the body from destroying platelets.
If the ITP doesn't get better, doctors can use other treatments. These include:
Surgery to remove the spleen – The spleen is an organ in the body's immune system that helps protect the body from infections (figure 1). Removing the spleen stops the body from destroying platelets.
Other medicines that stop the body from destroying platelets, such as rituximab. This is given through a thin tube that goes into a vein, called an "IV."
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, they can have serious bleeding. 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 and drugs called non-steroidal anti-inflammatory drugs (or "NSAIDs"), affect platelets. 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. Babies born with low platelet counts will get better in a few days. But the platelet count can go lower before it improves, so it is important to check the baby.
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This topic retrieved from UpToDate on: Mar 30, 2020.
Topic 16735 Version 12.0
Release: 28.2.2 - C28.105
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