ITP, or immune thrombocytopenia, is a blood clotting disorder caused by a low number of platelets. It can be either acute or chronic but is rarely life threatening. Most cases are treatable with medication.

ITP is an immune disorder in which blood doesn’t clot quickly because the body lacks enough platelets. As a result, ITP can lead to excessive bruising and bleeding internally, as well as on and under the skin.

ITP used to be called idiopathic thrombocytopenic purpura, but it’s now known as immune thrombocytopenia.

The condition is no longer idiopathic (which means there’s no known cause) because researchers now know the condition is autoimmune. “Purpura” was dropped from the name because around one-third of those who receive a diagnosis have no bleeding.

Because of their low platelet count, people with ITP often have many purple bruises called purpura on their skin or inside their mouth. These bruises may also appear as pinpoint-sized red or purple dots, kind of like a rash, on the skin, that are called petechiae. On darker skin tones, they may appear dark brown or black.

While ITP can affect anyone, it’s more common in adults over age 60 years.

About 40% of all cases affect children under 10 years old, though it seems to develop most frequently in kids between ages 2 and 4 years. This is especially true after they’ve been sick with another viral illness like chickenpox, mumps, and measles.

The two main types of ITP:

  • Acute ITP: This type is short-term, lasting less than 6 months. It’s the most common form of the disorder in children.
  • Chronic ITP: This long-term form lasts 6 months or longer and is most commonly seen in adults, though it can affect anyone.

Platelets are created in the bone marrow. They help blood cells stick to each other and proteins to seal and heal wounds and cuts. But when platelet levels are low, as they are with ITP, it takes longer for wounds to stop bleeding and heal.

Platelet levels are low with ITP because with this immune disorder, your immune system antibodies attack and destroy platelets.

ITP is not contagious and cannot be passed from one person to another. But it can be classified as primary, meaning it occurs on its own, or it can be secondary, which means that another condition triggers it.

Possible triggers for secondary ITP include:

ITP doesn’t always cause noticeable symptoms. Someone with ITP can also be asymptomatic for long periods of time and not have any symptoms until they have an episode.

If there are symptoms, the most common ones include:

  • easy bruising, even if you don’t remember bumping something
  • pinpoint-sized petechiae, or reddish-purple dots that almost look like a rash on your skin, usually on your lower legs
  • spontaneous nosebleeds
  • gum bleeding
  • cuts that take a long time to stop bleeding or scab over
  • blood in the urine
  • blood in the stool
  • abnormally heavy menstruation
  • profuse bleeding during surgery

To receive an ITP diagnosis, your doctor will start by performing a complete physical exam. They’ll ask you about your medical history and the medications you’re taking.

Your doctor will also order blood tests that could measure:

Your doctor will also request a blood smear. During this procedure, a healthcare professional will take a blood sample. It’s placed on a glass slide and viewed under a microscope to verify the number and appearance of platelets seen in the complete blood count.

If you have a low platelet count, your doctor may also order abone marrow test. If your bone marrow is abnormal, another disease rather than ITP is likely causing your low platelet count.

But if you have ITP, your bone marrow will be normal. This is because your platelets are destroyed in the bloodstream and spleen after they leave the bone marrow, not in your bone marrow itself.

Your doctor will choose your treatment based on the following:

  • your total number of platelets
  • how often you bleed
  • how much you bleed

In some cases, treatment isn’t needed. For example, children who develop the acute form of ITP usually recover within 6 months or less without treatment.

Adults with less severe cases of ITP may also not require treatment. However, your doctor will still want to monitor your platelet and red blood cell counts to ensure that you don’t need treatment in the future.

Platelet counts that drop too low put you at risk of spontaneous bleeding in the brain or other organs, while a low red blood cell count can be a sign of internal bleeding.

Medications

If you or your child requires treatment, your doctor will likely prescribe medications as the first course of treatment. The most common medications used to treat ITP include:

Corticosteroids

Your doctor may prescribe a corticosteroid like prednisone (Rayos), which can increase your platelet count by decreasing the activity of your immune system.

Intravenous immunoglobulin (IVIg)

If your bleeding has reached a critical level or you’re going to have surgery and need to increase your platelet count quickly, you may be given intravenous immunoglobulin (IVIg).

Anti-D immunoglobulin

This is for people who have Rh-positive blood. Like IVIg therapy, it can quickly increase the platelet count, and it may work even faster than IVIg. However, it can have serious side effects, so individuals should be careful with this treatment.

Rituximab (Rituxan)

This antibody therapy targets the immune cells responsible for producing the proteins that attack platelets. When this medication binds to those immune cells, known as B cells, they’re destroyed.

This means fewer cells are available to make the proteins that attack platelets.

Thrombopoietin receptor agonists

Thrombopoietin receptor agonists, including romiplostim (Nplate) and eltrombopag (Promacta), help prevent bruising and bleeding by stimulating the bone marrow to produce more platelets.

The Food and Drug Administration (FDA) has approved both of these medications for the treatment of low platelet counts due to chronic ITP.

General immunosuppressants

General immunosuppressants are generally only prescribed if the other drugs listed above do not improve your symptoms and if you have a severe case of ITP.

Immunosuppressants inhibit the overall activity of the immune system, not just the specific components related to ITP. As a result, they can have significant side effects.

These medications are generally avoided today.

Antibiotics

Helicobacter pylori, which is the bacteria that causes most peptic ulcers, has been associated with ITP in some people. So if other medications do not work, some doctors may consider prescribing antibiotic therapy to eliminate H. pylori because that has been shown to help increase platelet counts in some people.

But more research is still needed on the effectiveness of this strategy, so it’s not considered standard treatment.

Surgery

If you have severe ITP and medication does not improve your symptoms or platelet count, your doctor may advise having surgery to remove your spleen. This is called a splenectomy.

Splenectomy isn’t usually performed in children because of the high rate of spontaneous remission or unexpected improvement. Having a splenectomy also increases the risk of certain bacterial infections in the future.

Emergency treatment

Severe or widespread ITP requires emergency treatment. This usually includes transfusions of concentrated platelets and intravenous administration of a corticosteroid like methylprednisolone (Medrol), IVIg, or anti-D treatments.

Lifestyle changes

Your doctor may also advise you to make some lifestyle changes, including:

  • avoiding the blood-thinning medication warfarin (Coumadin) and certain over-the-counter drugs that can affect platelet function like aspirin and ibuprofen (Advil, Motrin)
  • limiting your intake of alcohol (consuming alcohol can adversely affect blood clotting)
  • choosing low impact activities instead of competitive sports or other high impact activities to decrease your risk of injury and bleeding

Treatment for pregnant people with ITP depends on the platelet count. If you have a mild case of ITP, you probably won’t need any treatment other than careful monitoring and regular blood tests.

But if you have an extremely low platelet count and it’s late in the pregnancy, you’re more likely to experience serious, heavy bleeding during and after delivery. In these cases, your doctor will work with you to determine a treatment plan that will help maintain a safe platelet count without adversely affecting your baby.

If you experience ITP along with other serious conditions of pregnancy, such as preeclampsia, you’ll need treatment as well.

Although most babies born to mothers with ITP aren’t affected by the disorder, some are born with or develop a low platelet count soon after birth. Treatment may be necessary for babies with very low platelet counts.

The most dangerous complication of ITP is bleeding, especially bleeding into the brain, which can be fatal. But serious bleeding is rare.

In fact, some of the treatments for ITP can have more risks than the disease itself. For example, the long-term use of corticosteroids can cause serious side effects, including:

Surgery to remove the spleen increases your risk of bacterial infections and the risk of becoming seriously ill if you develop an infection. If you have a splenectomy, it’s important to watch for any symptoms of infection and report them to your doctor promptly.

For most people with ITP, the condition isn’t serious or life threatening.

For example, acute ITP in children often resolves within 6 months or less without treatment. Chronic ITP, though, can last for many years. Still, people can live for many decades with the disease, even those with severe cases.

Many people with ITP are able to manage their condition safely without any long-term complications or a decreased life span.