Immune thrombocytopenia (ITP), also called immune thrombocytopenic purpura, is a condition where the body has too few platelets. Platelets are tiny cells in the blood that help stop bleeding by forming clots. They are made in the bone marrow—the soft center inside bones. When platelet levels drop, it becomes easier for a child to bruise or bleed.
What causes ITP?
It is unknown what exactly causes the body to start lowering the platelet count in the blood or bone marrow. But ITP often starts after infections, taking certain medications or developing other health conditions. With ITP, the immune system—which normally fights germs—mistakes healthy platelets for something harmful and destroys them. This mix-up lowers the number of platelets in the blood, making bruising and bleeding more likely.
What are the signs & symptoms of ITP?
Many or large bruises on the skin
Small flat, red spots (called petechiae) on the skin or inside the mouth
Nose bleeds
Heavy menstrual bleeding
Blood in the urine or stool
Bleeding in the brain is very rare
How is ITP diagnosed?
If a person develops any of these signs and symptoms, a health care professional will ask some questions and perform a complete physical examination. Blood drawn from a vein will test for a complete blood count to measure the platelet number and other blood cells. Other blood tests can also be done.
In ITP, the platelet count will be low while the other blood cells and blood tests obtained are usually normal. A hematologist, a doctor with knowledge in blood problems, will help with diagnosis and possible treatments.
How is ITP treated?
In up to 80% of children, the platelet count usually returns to normal within 3 to 12 months from diagnosis. Treatment may or may not be needed. There are many different types of treatments for ITP. However, the treatment of your child's ITP will be a discussion between you and their doctor.
More commonly used treatments to raise the platelet count faster include:
Observation. Many children can be safely watched, and the platelet count will go back to normal on its own.
Corticosteroids, medications that can be taken by mouth or injected into a vein.
Intravenous immunoglobin (IVIg), a blood product infused into a vein.
Based upon symptoms and the platelet count, the above therapies may be given at home, in a special clinic or in the hospital. Depending on the improvement in symptoms and rise in the platelet count, these treatments can be taken again, or different medications could be needed.
How can we prevent bleeding problems at home and school?
Your child's doctor may recommend avoiding activities that increase the risk of bleeding problems. A general rule is that an activity is allowed "if you can keep one foot on the ground."
Talk with your child's doctor about returning to more aggressive activities (needing a helmet for safety) or contact sports (such as boxing or tackle football). Many activities that do not cause head injury are acceptable.
All people with ITP need to avoid non-steroidal anti-inflammatory drugs such as ibuprofen and aspirin. These medications increase bleeding. Please review all medications with your child's doctor during their visit.
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