Idiopathic Thrombocytopenic Purpura
(Immune Thrombocytopenic Purpura; ITP)
Pronunciation: ID-ee-oh-PATH-ic Throm-boh-SIGH-toh-peen-ick Pur-PUR-ahEn Español (Spanish Version)
Idiopathic thrombocytopenic purpura (ITP) is a blood disorder in which antibodies produced in the spleen attack and destroy the body’s own blood clotting cells, called platelets. Platelets help stop bleeding by traveling to a damaged area of the body and sticking together to form a sort of barrier against germs. If there are not enough platelets in the body, it becomes difficult to stop bleeding from injuries such as cuts or bruises.
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Although people with ITP have a lower than normal number of platelets in their blood, all of their other blood cell counts are normal.
There are two types of ITP:
- Acute ITP—lasts less than six months; this type of ITP usually occurs in children and is the most common type of ITP.
- Chronic ITP—lasts longer than six months; this type of ITP usually occurs in adults.
ITP is treatable. If you think you may have this disorder, contact your physician.
The cause of most cases of ITP is unknown.
In children, the disorder has been linked to having had a recent viral infection. It is believed that sometimes a child’s immune system can become confused by the infection and begin attacking healthy platelet cells instead of harmful cells. When too many platelets are destroyed, ITP can result. The disorder in adults has not been linked to viral infections.
Some cases of ITP are thought to be caused by drugs, infection, or other immune disorders.
Pregnant women sometimes develop the disorder.
The following factors increase your chances of developing ITP:
- Children with a recent viral infection or live virus vaccination—This is thought to sometimes put a child at a higher risk for developing ITP.
- Women, usually younger than 40—They are diagnosed with chronic ITP 2-3 times more often than men.
If you experience any of the following symptoms, do not assume it is due to ITP. These symptoms may be caused by other, less serious health conditions. If you experience any one of them, see your physician.
Both adults and children may notice the following symptoms:
- Easy bruising
- Dark urine or stools
- Bleeding for longer than normal following an injury
- Unexplained nosebleeds
- Bleeding from the gums
- In adult women, heavier-than-normal menstrual periods
Red dots called “petechiae” on the skin
- Petechiae may occur in groups and resemble a rash.
- In rare cases, bleeding within the intestinal tract, blood in the bowel movements, or bleeding in the brain can occur. Most people with ITP never experience those symptoms.
Your doctor will ask about your symptoms and medical history, and perform a physical exam.
Tests may include the following:
- Complete blood count (CBC)—A blood sample is taken and tested to see if the numbers of different blood cells are normal.
- Bone marrow test —A needle is inserted in the skin and into the bone. A small amount of bone marrow is removed to be sure there are normal numbers of platelet-producing cells in the marrow, and to rule out other disorders.
- CT scan (in rare cases)—This is done if there is a concern about bleeding in the brain.
Treatment for ITP is different for children and adults. Talk with your doctor about the best treatment plan for you.
Most children recover from ITP without any intervention or treatment. However, your doctor may recommend the following treatments:
Prednisone is a steroid treatment. Steroids help treat ITP by lowering the activity of the immune system, thus keeping it from destroying platelets.
Gamma globulin infusions are an antibody-containing protein that slows down platelet destruction. An infusion means that gamma globulin is given intravenously, or through a shot. It usually works more quickly than steroid medication.
Both of these treatments work by increasing platelet counts in the blood, but both can have side effects. Eighty-five percent of children who have ITP recover within a year and do not experience the problem again.
In adults, treatment also aims to increase platelet counts. Like children, adult patients may be given prednisone or gamma globulin infusions. However, if drug intervention does not do enough to raise platelet counts, the doctor may recommend a splenectomy .
Splenectomy is the surgical removal of the spleen. Removal of the spleen stops the destruction of platelets by antibodies produced in the spleen, but it also leaves the body more vulnerable to infection from other sources. This surgery is usually not performed until it has been determined that the medications are not effective.
Doctors sometimes recommend lifestyle changes, such as avoiding contact sports or wearing a helmet, when platelet counts are low.
Since the cause of ITP is unknown, there are no specific ways of preventing it. However, there are steps that can be taken to help prevent bleeding and injuries that are more serious for people with ITP.
- Take precautions such as padding an infant's crib or play area.
- Make sure that older children wear helmets and protective gear when playing sports to help reduce bruising injuries.
- When platelet counts are low, contact sports such as football and even rougher game playing may have to be stopped temporarily.
- People who have ITP should also avoid medications that contain aspirin or ibuprofen; these medicines can reduce platelet function.
To help stay healthy, you should:
- Eat a healthful diet , one that is low in saturated fat and rich in whole grains, fruits, and vegetables.
- Get regular exercise .
- If you are overweight, lose weight .
- Don’t smoke. If you smoke, quit .
- Drink alcohol only in moderation. Moderate alcohol intake is two drinks per day for men and one drink per day for women.
American Academy of Family Physicians
National Heart, Lung, and Blood Institute
National Institute of Diabetes and Digestive and Kidney Diseases
BC Health Guide
Canadian Medical Association Journal
George JN, Woolf SH, Raskob GE, et al. Idiopathic thrombocytopenic purpura: a practice guideline developed by explicit methods for The American Society of Hematology. American Society of Hematology website. Available at: http://www.hematology.org/practice/idiopathic.cfm . Accessed Dec 12, 2006.
Karpatkin S. Autoimmune (idiopathic) thrombocytopenic purpura. Lancet . 1997;349:1531-1536.
Last reviewed January 2008 by Igor Puzanov, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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