Idiopathic thrombocytopenic purpura (ITP) is a disorder that can lead to easy or excessive bruising and bleeding. It is accompanied by unusually low levels of platelets (the cells that cause the blood to clot).
Idiopathic thrombocytopenic purpura affects both children and adults. Children are more likely to develop ITP after a viral infection and usually recover without treatment. However, in adults, the condition often becomes chronic.
Chronic or severe cases of ITP require treatment with medications or in rare and critical cases, with surgery.
ITP may show no signs or symptoms; however, when symptoms occur, they may include:
- Easy or excessive bruising (purpura)
- Superficial bleeding into the skin that appears as a rash (usually occurs on the lower legs)
- Prolonged bleeding from cuts
- Spontaneous nose bleeds
- Blood in urine or stools
- Unusually heavy menstrual flow
- Bleeding gums (especially after dental work)
The exact cause of idiopathic thrombocytopenic purpura is unknown. Idiopathic carries the meaning of “unknown cause.” However, it is known that in people with ITP, the immune system malfunctions and attacks platelets as if they are foreign substances. This process results in a lower number of circulating platelets. As the number of platelets decreases, the risk of bleeding increases. In a platelet count below 10,000 there is a high risk of internal bleeding despite the lack of an injury.
In children, ITP usually follows a viral illness, but it may be an infection that triggers the immune system and leads to its malfunction.
Factors that increase the risk of ITP include:
- Gender: women are more likely to develop ITP than men
- Recent viral infection: children are more likely to develop ITP after a viral infection
The most serious complication associated with ITP is bleeding, especially bleeding into the brain (intracranial hemorrhage), which can be fatal. However, major bleeding rarely occurs with ITP.
Corticosteroids are used to treat chronic or severe ITP. Long-term use of corticosteroids may lead to complications such as bone loss, cataracts and high blood sugar levels.
Removal of the spleen (splenectomy) helps prevent the loss of platelets. However, a splenectomy causes permanent vulnerability to infection but the risk is generally low.
Pregnant women with mild ITP usually have a normal pregnancy and delivery; however, antibodies to platelets may cross the placenta and affect the baby’s platelet count. This requires regular monitoring of the baby to ensure that the platelet count of the baby improves.
Pregnant women with a very low platelet count have an increased risk of heavy bleeding during delivery. Therefore, treatment to maintain a stable platelet count may be necessary.
Treatment of ITP focuses on ensuring a safe and stable platelet count and preventing bleeding complications.
Treatment usually involves medications or in some cases, surgery (splenectomy).
- Corticosteroids to help raise platelet count by decreasing the activity of the immune system.
- Intravenous immune globulin (IVIG) to counter bleeding and to help increase the blood count before surgery.
- Thrombopoietin receptor agonists to help the bone marrow produce more platelets, which helps prevent bruising and bleeding.
- Biologic therapy is used to reduce the immune system response in people with severe ITP.
A severe case of ITP may require removal of the spleen. This counters the source of platelet destruction in the body and improves platelet count. A splenectomy may not be as effective for everyone and it is rarely performed on children due to their high rate of spontaneous remission.
In rare cases, severe bleeding can occur with ITP, which is a life-threatening situation that requires immediate medical attention. This includes transfusions of platelet concentrates, intravenous methylprednisolone and intravenous immune globulin.
- Immunosuppressant drugs
- H. pylori treatment that may increase platelet count