What Is Idiopathic Thrombocytopenic Purpura
Idiopathic thrombocytopenic purpura (ITP) is a
bleeding condition in which the blood doesnt clot as it should. This is
due to a low number of blood cells called platelets (PLATE-lets).
Platelets are also called thrombocytes
(THROM-bo-sites), and theyre made in your bone marrow (along with other
kinds of blood cells). Platelets circulate through the blood vessels and help
stop bleeding by sticking together (clotting) to seal small cuts or breaks.
Idiopathic (id-ee-o-PATH-ick) means that the cause
of the disease or condition isnt known. Thrombocytopenic
(throm-bo-cy-toe-PEE-nick) means there is a lower-than-normal number of
platelets in the blood. Purpura (PURR-purr-ah) are purple bruises caused by
bleeding under the skin. More extensive bleeding can create a three-dimensional
mass called a hematoma (he-ma-TO-ma).
Purpura
The photograph show purpura
(bruises) in the skin. Bleeding under the skin causes the purple, brown, and
red color of the purpura.
People who have ITP often have purple bruises that
appear on the skin or on the mucous membranes (for example, in the mouth). The
bruises mean that bleeding has occurred in small blood vessels under the skin.
A person who has ITP also may have bleeding that results in tiny red or purple
dots on the skin. These dots, often seen on the lower legs, are called
petechiae (peh-TEE-kee-ay). Petechiae may look like a rash.
People with ITP may have nosebleeds, bleeding from
the gums when they have dental work done, or other bleeding thats hard to
stop. Women with ITP may have heavy menstrual bleeding.
Bleeding in the brain as a result of ITP is very
rare, but can be life threatening if it occurs.
In most cases, the bodys immune system is
thought to cause ITP. Normally your immune system helps your body fight off
infections and diseases, but if you have ITP, your immune system attacks and
destroys its own plateletsfor an unknown reason.
Types of Idiopathic Thrombocytopenic Purpura
There are two types of ITP: acute (temporary or
short-term) and chronic (long-lasting).
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. It often occurs after an infection caused by a virus.
Chronic ITP is long-lasting (6 months or longer) and
mostly affects adults. However, some teenagers and even younger children can
get this type of ITP. Chronic ITP affects women 2 to 3 times more often than
men. Treatment depends on how severe the bleeding symptoms are and the platelet
count. In mild cases, treatment may not be needed.
Outlook
For most children and adults, ITP isnt a
serious or life-threatening condition.
Acute ITP in children often goes away on its own
within a few weeks or months and doesnt return. In 80 percent of children
who have ITP, the platelet count returns to normal within 6 to 12 months.
Treatment may not be needed. A small number of children, about 5 percent, whose
ITP doesnt go away on its own may need to have further medical or
surgical treatment.
Chronic ITP will vary with each individual and can
last many years. Even people who have severe forms of chronic ITP can live for
decades. Most people with chronic ITP are able at some point to stop treatment
and keep a safe platelet count.
Other Names for Idiopathic Thrombocytopenic
Purpura
- Immune thrombocytopenic purpura
- Autoimmune thrombocytopenic purpura
What Causes Idiopathic Thrombocytopenic Purpura?
In most cases, it's believed that the body's immune
system causes idiopathic thrombocytopenic purpura (ITP). Normally, the immune
system makes antibodies to fight off germs or other harmful things that enter
the body. In ITP, however, the immune system treats your own platelets as if
they were invaders in the body, attacking and destroying them.
The reason why the immune system decides to attack
its own platelets isn 't known.
Children who get the acute (temporary) type of ITP
often have had a recent viral infection. It's possible that the infection
somehow "triggers" or sets off the immune reaction that leads to ITP in these
children. ITP in adults, on the other hand, doesn't seem to be linked to
infections.
Who Is At Risk for Idiopathic Thrombocytopenic
Purpura?
Both children and adults can develop idiopathic
thrombocytopenic purpura (ITP).
Children usually get the acute (temporary) type of
ITP. This type of ITP often develops after an infection caused by a virus.
Adults tend to get the chronic (long-lasting) type of ITP. Women are 2 to 3
times more likely than men to get chronic ITP.
ITP is a fairly common blood disorder, with 50 to
150 new cases per every 1 million people each year; about half of these cases
are in children. However, the number of cases of ITP is increasing because
routine blood tests that show a low platelet count are being done more
often.
You cant catch ITP from another person.
What Are the Signs and Symptoms of Idiopathic
Thrombocytopenic Purpura?
Having a low platelet count doesnt cause
symptoms. The bleeding caused by a low platelet count may have the following
signs or symptoms.
- Pinpoint red spots on the skin (frequently the
legs) that can often be found in groups and may look like a rash. The spots,
called petechiae, are due to bleeding under the skin.
- Bruising or purplish areas on the skin or mucous
membranes (such as in the mouth) due to bleeding under the skin. The bruises
may occur for no apparent reason. This type of bruising is called purpura. More
extensive bleeding can create a three-dimensional mass called a hematoma.
- Nosebleeds or bleeding from the gums (for
example, when dental work is done).
- Blood in the urine or stool (bowel movement).
Any kind of bleeding that's hard to stop could be a
sign of ITP. This includes heavy menstrual bleeding in women.
Bleeding in the brain is rare, and the symptoms of
bleeding in the brain may vary in severity.
A low number of platelets won't cause pain, fatigue
(tiredness), difficulty concentrating, or any other symptoms.
How Is Idiopathic Thrombocytopenic Purpura
Diagnosed?
To diagnose idiopathic thrombocytopenic purpura
(ITP), your doctor must first be certain that your low platelet count isn't
caused by other conditions, such as HIV infection or lupus, or by medicines
(for example, chemotherapy drugs or aspirin). Your doctor will ask about your
medical history, do a physical exam, and order blood tests.
Your medical history includes information about:
- Your signs and symptoms of bleeding
- Illnesses you have that could lower your platelet
count or cause bleeding
- Medicines or any other over-the-counter
supplements or remedies you take that could cause bleeding or lower your
platelet count
Your doctor will give you a physical exam and look
for signs of bleeding and infection.
He or she also will order blood tests to measure the
platelet count in your blood. These tests usually include:
- A complete blood count. This test shows the
numbers of different kinds of blood cells, including platelets, in a small
sample of your blood. In ITP, the red and white blood cell counts are normal.
- A blood smear. During this test, some of your
blood is put on a slide. A microscope is then used to look at your platelets
and other blood cells.
- Some laboratories may be able to test for the
antibodies that attack platelets.
If blood tests show that you have a low number of
platelets, your doctor may need to order more tests to confirm a diagnosis of
ITP. For example, bone marrow tests may be used to see if the large cells that
make platelets look normal. (These large cells are called megakaryocytes.)
Some people with mild ITP have few or no signs of
bleeding. In that case, they might be diagnosed only after a blood test done
for another reason shows that they have a low number of platelets.
How Is Idiopathic Thrombocytopenic Purpura
Treated?
Treatment for idiopathic thrombocytopenic purpura
(ITP) is based on how much and how often youre bleeding and your platelet
count. Medicines are often used as the first course of treatment. Treatments
used for children and adults are similar.
Adults with ITP who have very low platelet counts or
problems with bleeding are usually treated. Adults who have milder cases of ITP
may not need any treatment, other than monitoring their symptoms and platelet
counts.
The acute (short-term) type of ITP that occurs in
children often goes away within a few weeks or months. Children who have
bleeding symptoms, other than merely bruising (purpura), are usually treated.
Milder cases in children may not need treatment other than monitoring and
followup to be sure platelet counts return to normal.
Medicines
If treatment is needed for adults or children who
have ITP, medicines are usually used first. Corticosteroids
(cor-ti-co-STEER-roids), such as prednisone, are commonly used to treat ITP.
These medicines, called steroids for short, help raise the platelet count in
the blood by lowering the activity of the immune system. However, steroids have
a number of side effects, and some people relapse (get worse) when treatment
ends.
Some medicines used to help raise the platelet count
are given through a needle in a vein. These medicines include immune globulin
and anti-Rh (D) immunoglobulin.
Experimental medicines may be tried if these
treatments dont help. Medicines may be used along with a procedure to
remove the spleen, called splenectomy (splee-NECK-tuh-mee).
Removal of the Spleen (Splenectomy)
If necessary, the spleen will be removed surgically.
This organ is located in the upper left abdomen and is about the size of a golf
ball in children and a baseball in adults. If ITP hasnt responded to
steroids, removing the spleen will reduce the destruction of platelets, but it
also may make you more likely to get certain types of infections. If your
spleen is removed, discuss with your doctor steps you can take to help avoid
these infections and the symptoms to watch out for.
Other Treatments
Platelet Tansfusions
Some people with ITP who have severe bleeding may
need to have platelet transfusions and be hospitalized. Some will need a
platelet transfusion before having surgery. For a platelet transfusion, donor
platelets from a blood bank are injected into the recipient's bloodstream to
increase the platelet count for a short time.
Treating Infections
Some types of infections can briefly lower a
persons platelet count. If a person with ITP has an infection that can
lower the number of platelets, treating the infection may help raise the
platelet count and reduce bleeding problems.
Stopping Medicines
If a person who has ITP is taking medicine that can
lower the number of platelets or cause bleeding, stopping the medicine can
sometimes help raise the platelet count or prevent bleeding. For example,
aspirin and ibuprofen are common medicines that reduce platelet function and
increase the chance of bleeding. If you have ITP, you shouldnt use these
medicines.
How Can Idiopathic Thrombocytopenic Purpura Be
Prevented?
You can't prevent idiopathic thrombocytopenic
purpura (ITP) from occurring, but you can prevent its complications.
- Avoid medicines such as aspirin or ibuprofen that
can affect your platelets and increase your risk for bleeding.
- Protect yourself from injuries that can cause
bruising or bleeding.
- Seek treatment right away for any infections you
may develop. Report any symptoms of infection, such as a fever, to your doctor.
This is especially important for adults or children with ITP who have had their
spleens removed.
Living With Idiopathic Thrombocytopenic
Purpura
If you have idiopathic thrombocytopenic purpura
(ITP):
- Stay away from medicines that may affect
platelets and increase your chance of bleeding. Common examples are aspirin or
ibuprofen. Be careful when using over-the-counter medicines, as many of them do
contain aspirin or ibuprofen. Tell your doctor about all of the
over-the-counter medicines you take, including vitamins, supplements, or herbal
remedies, as they could contain substances that increase your risk of bleeding.
- Avoid injuries that can cause bruising and
bleeding. Take precautions such as regular use of seatbelts and wearing gloves
when working with knives and other tools. If your child has ITP, protecting him
or her from injuries, especially head injuries that could cause bleeding in the
brain, is important. Ask your child's doctor whether you need to restrict your
child's activities.
- Find a doctor who is familiar with treating ITP
patients. Hematologists are doctors who specialize in diagnosing and treating
blood diseases and disorders.
- Watch for symptoms of infection, such as fever,
and report them to your doctor promptly. If you have had your spleen removed,
you may be more likely to become ill from certain types of infections. People
who have had a splenectomy should receive certain vaccinations to prevent these
infections. Your doctor can tell you which vaccinations you should have.
Idiopathic Thrombocytopenic Purpura in Pregnancy
In women who are pregnant and have ITP, the ITP
usually doesn't affect the baby. However, some babies born to mothers with ITP
are born with or develop low numbers of platelets soon after birth. Their
platelets almost always return to normal without any treatment. Treatment can
speed the recovery in the few babies whose platelet counts are very low.
Treatment for ITP during pregnancy depends on the
woman's platelet count. If treatment is needed, the doctor will take a close
look at the possible effects of the treatment on the unborn baby.
Women who have milder cases of ITP can usually go
through pregnancy without treatment. Pregnant women with very low platelet
counts or a lot of bleeding are more likely to have serious heavy bleeding
during delivery or afterward. To prevent serious bleeding, these women are
usually treated.
Key Points
- Idiopathic thrombocytopenic purpura (ITP) is a
bleeding condition in which the blood doesn't clot as it should. This is due to
a low number of blood cells called platelets.
- Platelets circulate through the blood vessels and
help stop bleeding by sticking together (clotting) to seal small cuts or
breaks.
- In most cases, the body's immune system is
thought to cause ITP. Normally your immune system helps your body fight off
infections and diseases, but if you have ITP, your immune system attacks and
destroys its own platelets—for an unknown reason.
- ITP can affect children and adults of all ages.
More women than men get ITP.
- There are two types of ITP. Acute ITP is usually
a short-term illness that usually affects children and often occurs after a
viral infection. Most children get well quickly without any treatment. Adults
most often have long-lasting (chronic) ITP. Symptoms can vary a great deal, and
some adults who have mild ITP don't need treatment
- People with ITP may have signs of bleeding, such
as bruises (purpura) that appear for no reason or tiny red dots (petechiae)
that are visible on the skin.
- Bleeding in ITP also occurs in the form of
nosebleeds, bleeding gums, heavy menstrual bleeding, or other bleeding that's
hard to stop. Bleeding in the brain as a result of ITP is very rare, but can be
life threatening when it occurs.
- ITP is diagnosed based on your medical history, a
physical exam, and results from blood tests.
- Treatment depends on the type and severity of the
illness. Those who have more severe symptoms are usually first treated with
medicines such as steroids.
- The spleen is sometimes removed if treatment with
medicine fails to keep the platelet level high enough to prevent bleeding.
- You can't prevent ITP, but you can prevent its
complications. Avoid medicines that can affect your platelets (such as aspirin
and ibuprofen), protect yourself from injuries that can cause bruising or
bleeding, and seek treatment if any signs of infection develop.
Links to Other Information About Idiopathic
Thrombocytopenic Purpura
Non-NHLBI Resources
Clinical Trials
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