Immune Thrombocytopenia (ITP)

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What is immune thrombocytopenia (ITP)?

Immune thrombocytopenia (ITP) is an autoimmune disorder that causes low numbers of platelets. Platelets are blood cells that help stop bleeding.

When your child’s platelet count is low, it can cause your child to bruise and bleed more easily. Your child might bleed more than normal when hurt or bleed for no reason.

When your child has a cut or injury, platelets come together to form a clot or “plug” to stop the bleeding. If the body does not have enough platelets, a clot cannot form.

A normal platelet count is 150,000 to 400,000 per microliter of blood. Serious bleeding can occur when the platelet count is less than 10,000.

Platelet Count Range	What it Means
150,000 – 450,000 / microliter	Normal platelet count
50,000 – 100,000 / microliter	Minor risk for bleeding with injury
Less than 50,000 / microliter	Increased bruising
Less than 20,000 / microliter	At risk for spontaneous bleeding
Less than 10,000 / microliter	At risk for serious bleeding

Platelet counts are given as the number of platelets per microliter (µL) of blood.
This information is meant to be a general guide. Always consult your care team for information about specific test results and what they mean.

Types of ITP

There are 2 types of ITP:

Primary ITP is a disease where the body’s immune system attacks and destroys its own platelets. About 80% (8 in 10) of patients with ITP have primary ITP.
Secondary ITP is a disease where the body’s immune system attacks and destroys its own platelets because the patient has an underlying disease or reason, like an infection, medicine, or another autoimmune disease.

ITP is classified by how long your child has had it:

Newly diagnosed ITP is the stage within the first 3 months since diagnosis. ITP is often short-term and platelet counts may return to normal within this time.
Persistent ITP lasts between 3 and 12 months.
Chronic ITP lasts 12 months or longer.

ITP can develop quickly. In most cases, platelet counts return to normal over weeks or months. However, counts can vary for some time.

Other names for ITP include idiopathic thrombocytopenic purpura, autoimmune thrombocytopenic purpura, immune thrombocytopenic purpura, Werlhof disease, and autoimmune thrombocytopenia.

Symptoms of ITP

Signs and symptoms of ITP include:

Petechiae: small red or purple “pinpoint” dots on the skin that may look like a rash
Bruising or purplish spots on the skin, lips, or inside the mouth
Bleeding from nose or gums
Blood in urine (pee)
Stool (poop) that is black or bloody
Bleeding during a menstrual period that is heavier or lasts longer than normal
Hematoma (a big bruise)
Feeling tired

Petechiae are small, red or purple "pinpoint" dots on the skin that may look like a rash — Children with ITP may have petechiae, which are flat, rash-like dots on the skin due to bleeding.

Causes of ITP

In most cases, the cause of ITP is not known. ITP is not contagious.

Normally, the body makes antibodies to fight an infection. In children with ITP, the body also makes antibodies that fight against the body’s own platelets. This causes the platelets to be destroyed.

ITP often affects healthy children. Sometimes, it may develop after a viral infection or in patients who have problems with their immune system.

Diagnosis of ITP

ITP is diagnosed based on your child’s medical history, physical exam, and lab tests. Your child's doctor may ask you about any changes in bleeding or bruising, recent illnesses, or medicines your child is taking.

Lab tests may include:

Complete blood count (CBC) to measure the number and size of platelets and other blood cells.
Blood smear to look at cells under a microscope to check the shape and size of platelets and other blood cells.
Urine and stool tests to check for blood in the urine (pee) or stool (poop).
Other blood tests to look for other possible causes of low platelets.
Bone marrow testing to make sure that platelets are being made normally.
Genetic testing to check for inherited disorders or gene changes that cause low platelets in children with chronic ITP.

Treatments for ITP

Not all children need treatment for ITP. Many children recover on their own. Your care team may recommend careful monitoring of your child’s blood counts and symptoms to see when and if treatment is needed.

Your child’s doctor may prescribe medicines to help manage ITP.

Medicines for ITP include:

Corticosteroids such as prednisone can be given in a pill or liquid form to slow the destruction of platelets.
Intravenous immune globulin (IVIG) or WinRho® are given by intravenous (IV) infusion into a vein. These medicines slow down the destruction of platelets.
Rituximab (Rituxan®) is a medicine given into a vein by IV that works to reduce the antibodies that attack platelets.
Eltrombopag (Promacta®), given by mouth, and romiplostim (Nplate®), given by injection, help the body make more platelets.
Other medications may be used to suppress the immune system.

General medicines for bleeding symptoms include:

Aminocaproic acid (Amicar®) can be used for mouth or nose bleeds or heavy menstrual bleeding.
Hormone therapy may be used to help control heavy periods in girls.

Surgery to remove the spleen (splenectomy) can help some children with chronic ITP who have low platelets.

Platelet transfusions may be given if there is life-threatening bleeding or before a surgery or a procedure. In a platelet transfusion, donor platelets are given into a vein by IV.

Living with ITP

Know what activities to avoid. Children with ITP can do most daily activities. ITP should not stop your child from having fun. However, talk to the care team about activities your child should not do.

When platelet counts are low, your child should avoid contact sports, rough play, and activities that could involve falls or injury to the head or stomach.

Take steps to keep your child safe. Be sure your child wears a seatbelt. Use safety equipment such as a helmet, knee pads, elbow pads, and wrist pads during approved sports or activities.

Alert others of your child’s condition. Your child should tell an adult if they fall or hit their head. Be sure that people who will be with your child know about their medical condition and what to do if an accident occurs.

Do not give your child aspirin or ibuprofen (Motrin^®, Advil^®). These medicines can keep platelets from working properly. If needed, give acetaminophen (Tylenol^®) for headache, pain, or fever.

An Unpredictable Disease

Lauren Truong had to sit out from many activities because of immune thrombocytopenia (ITP), but now she runs cross-country.

Read Lauren's story

Low risk activities are walking, swimming, jogging, golf, dancing, and yoga. Medium risk activities are baseball, softball, soccer, basketball, bike riding. High risk activities are football, trampoline, skateboarding, lacrosse, gymnastics, diving, 4-wheeler riding, tree climbing, skating, and cheerleading. — Children with ITP should avoid certain activities when their platelet counts are low.

When to call your doctor

Most children with ITP do very well. Watch for signs and symptoms of low platelets or bleeding. Tell your doctor right away if your child has any of these symptoms:

Petechiae, bruising, or purplish areas on the skin or in the mouth
Gums that bleed easily
Nosebleeds
Blood in the urine or stool
Headache that won’t go away or gets worse, especially after a fall or accident

The main risk of ITP is severe bleeding. Very rarely, children with ITP may have serious internal bleeding.

Call your doctor or go to an emergency room right away if your child has any serious injury, especially one that involves a hit to the head or stomach.

Questions to ask the care team

What are the possible causes of my child’s ITP?
What is the best ITP treatment option for my child?
What are the possible side effects of treatment?
How will we know if the treatment is working?
How long will my child need treatment?
How often will my child need to have their platelet count checked?
What activities should my child avoid?
What warning signs should we watch for?

Key points about ITP

Immune Thrombocytopenia (ITP) is a disease that causes low platelets. It may lead to bruising and bleeding.
Most young children with ITP get better within 6 to 12 months. But it can continue and be chronic ITP.
Your care team will check platelet counts and recommend treatments as needed.
Take steps to prevent serious bleeding, watch for warning signs, and seek medical care when needed.

—
Reviewed: August 2024

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