Idiopathic thrombocytopenic purpura (ITP)
Idiopathic thrombocytopenic purpura (ITP)
Idiopathic thrombocytopenic purpura (ITP) is a disorder that can lead to easy or excessive bruising and bleeding. The bleeding results from unusually low levels of platelets — the cells that help your blood clot.
Idiopathic thrombocytopenic purpura, which is also called immune thrombocytopenic purpura, affects both children and adults. Children often develop idiopathic thrombocytopenic purpura after a viral infection and usually recover fully without treatment. In adults, however, the disorder is often chronic.
Treatment of idiopathic thrombocytopenic purpura depends on your symptoms, your platelet count and your age. If you don't have signs of bleeding and your platelet count isn't too low, treatment for idiopathic thrombocytopenic purpura usually isn't necessary. More serious cases may be treated with medications or, in critical situations, with surgery.
Idiopathic thrombocytopenic purpura (ITP) may have no symptoms. When signs and symptoms do occur, they may include:
When to see a doctor
Serious or widespread bleeding indicates an emergency and requires immediate care.
Petechiae may look like a rash and usually appear in clusters. Here they appear on a leg (A) and on an abdomen (B). ...
The exact cause of ITP isn't known. That's why it's referred to as idiopathic, which means "of unknown cause." It is known, however, that in people with idiopathic thrombocytopenic purpura, the immune system malfunctions and begins attacking platelets as if they were foreign substances.
Antibodies produced by your immune system attach themselves to the platelets, marking the platelets for destruction. The spleen, which helps your body fight infection, recognizes the antibodies and removes the platelets from your system. The result of this case of mistaken identity is a lower number of circulating platelets than is normal.
A normal platelet count is generally higher than 150,000 platelets per microliter of circulating blood. People with ITP often have platelet counts below 20,000. As the number of platelets decreases, your risk of bleeding increases. The greatest risk is when your platelet count falls very low — below 10,000 platelets per microliter. At this point, internal bleeding may occur despite a lack of any injury.
In most children with ITP, the disorder follows a viral illness, such as the mumps or the flu. It may be that an infection sets off the immune system, triggering it to malfunction.
ITP can occur in anyone at almost any age, but these factors increase your risk:
The biggest risk associated with idiopathic thrombocytopenic purpura is bleeding, especially bleeding into the brain (intracranial hemorrhage), which can be fatal. Major bleeding is rare with ITP, however.
Complications are more likely to arise from the treatments used for chronic or severe ITP. Corticosteroids are a first line treatment because they help dampen the immune system attack on the platelets. But, long-term use of corticosteroids can cause serious side effects, including bone loss (osteoporosis), cataracts and high blood sugar levels, possibly leading to type 2 diabetes.
Removal of your spleen (splenectomy), which may be performed if corticosteroids aren't working, helps prevent the loss of platelets. However, removing the spleen also makes you permanently more vulnerable to infection. Fortunately, the risk of an overwhelming infection in a healthy person who has had a splenectomy is low.
If you're pregnant and your platelet count is very low or you have bleeding, you have a greater risk of heavy bleeding during delivery. In such cases, you and your doctor may discuss treatment to maintain a stable platelet count, taking into account the effects on your baby.
Preparing for your appointment
Because a low platelet count may not cause symptoms, the problem is often discovered when you have a blood test for another reason. If your doctor thinks you might have ITP, you are likely to have further blood tests that require drawing a small amount of blood from a vein in your arm. You are also likely to be referred to a doctor who specializes in blood disorders (hematologist) for further evaluation and treatment.
Appointments, even with specialists, can be brief, and there's often a lot of ground to cover, so it can help to be prepared. Here are some tips to help you get ready for your appointment:
What you can do
Questions you may want to ask include:
Tests and diagnosis
Doctors usually diagnose idiopathic thrombocytopenic purpura by excluding other possible causes of bleeding and a low platelet count, such as an underlying illness or medications you may be taking. If no other underlying problem is causing your signs and symptoms, then a diagnosis of ITP may be made.
To diagnose ITP, your doctor may need a:
If you have ITP, your bone marrow will be normal because your low platelet count is caused by the destruction of platelets in your bloodstream and spleen — not by a problem with the bone marrow.
Treatments and drugs
The goal of treating ITP is to ensure a safe platelet count and prevent bleeding complications while minimizing treatment side effects.
In children, idiopathic thrombocytopenic purpura usually runs its course without the need for treatment. About 80 percent of children with idiopathic thrombocytopenic purpura recover completely within six months. Even in children who develop chronic ITP, complete recovery may still occur, even years later.
Adults with mild cases of ITP may require nothing more than regular monitoring and platelet checks. But if your symptoms are troublesome and your platelet count remains low, you and your doctor may opt for treatment. Treatment usually consists of medications and sometimes surgery (splenectomy). Your doctor may also have you discontinue certain drugs that can further inhibit platelet function, such as aspirin, ibuprofen (Advil, Motrin IB, others) and the blood-thinning medication warfarin (Coumadin).
Removal of your spleen (splenectomy)
Splenectomy is rarely performed in children because of their high rate of spontaneous remission.
Other possible treatments include:
Because of the potential complications of both the disease and its treatment, it's important for you and your doctor to carefully weigh the benefits and risks of treatment. For example, some people find that the side effects of treatment are more burdensome than the effects of the disease itself. Other factors that might affect your decision include whether or not you have other medical conditions or take medications that could increase your risk of bleeding, and whether or not you have an active lifestyle that could increase the risk of injury and bleeding.
Lifestyle and home remedies
If you have idiopathic thrombocytopenic purpura, the following steps may help control your risk of bleeding and other complications:
Last Updated: 2013-04-23
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