Immune thrombocytopenia

Overview

Immune thrombocytopenia (ITP) is a condition where your immune system mistakenly attacks your own platelets. Platelets are tiny cells in your blood that help stop bleeding by forming clots. When you don’t have enough platelets, you may bruise easily or bleed more than usual. ITP is not cancer and is not contagious.

ITP is not very common. It affects about 3 to 5 people in every 100,000 each year. In children, it is more common after a viral infection and often resolves without treatment.

ITP can occur at any age but is more common in children (usually after an infection) and in adults under 40. Women are slightly more likely to develop ITP than men. In older adults, it can also occur and may require more careful management.

Symptoms

Common symptoms

• Easy or excessive bruising (purpura) – large purple or blue patches on the skin.
• Petechiae – tiny red or purple dots on the skin, often on the lower legs, that look like a rash.
• Nosebleeds that are hard to stop.
• Bleeding from gums, especially after brushing teeth.
• Heavier than normal menstrual periods.
• Cuts or scrapes that bleed for a long time.

Symptoms in children

• Often appears suddenly after a viral infection (like chickenpox or flu).
• Bruising and petechiae are common.
• Nosebleeds or mouth bleeding may occur.
• Most children recover fully within weeks or months without treatment.

Symptoms in older adults

• Bruising and bleeding may be more frequent or severe.
• May also have fatigue or weakness due to ongoing bleeding.
• Can be mistaken for other age-related conditions, so it's important to see a doctor.

Causes

Main causes

• ITP is autoimmune – the immune system mistakenly attacks healthy platelets.
• In children, it often follows a viral infection, such as chickenpox, flu, or COVID-19.
• In adults, it may be triggered by infections, some medicines, or other immune conditions, but often the exact cause is unknown.

Risk factors

• Recent viral infection (common trigger in children).
• Autoimmune diseases such as lupus or rheumatoid arthritis.
• Certain medications (talk to your doctor about any new drugs).
• Pregnancy (some women develop temporary ITP).
• Family history of autoimmune conditions.

When to see a doctor

See a doctor urgently if:

• If you have unexplained bruising or a rash of tiny red dots that spreads quickly.
• If you have bleeding that is hard to stop from a small cut or nosebleed.
• If you see blood in your urine or stool.
• If you are bleeding heavily and feel dizzy or lightheaded.

Book a routine appointment if:

• If you notice easy bruising or petechiae that do not go away within a few days.
• If you have heavier than normal periods for several cycles.
• If you have a family history of ITP or other bleeding disorders and are concerned.

Diagnosis

ITP is diagnosed through a combination of a medical history, physical exam, and blood tests. Your doctor will ask about your symptoms, recent infections, and any medicines you take. They will check for bruises, petechiae, and signs of internal bleeding.

Tests that may be done

• Complete blood count (CBC) – measures platelets and other blood cells.
• Peripheral blood smear – a small sample of blood is looked at under a microscope to check platelet appearance.
• Platelet antibody test – finds antibodies that may be attacking platelets.
• Bone marrow biopsy (rarely needed) – to rule out other causes of low platelets.

What to expect at your appointment

Tests are usually quick and involve a blood draw from your arm. Your doctor may need to repeat tests to see if your platelet count is stable or dropping. You may be referred to a specialist doctor called a haematologist (a blood doctor) for further care.

Treatment

Treatment depends on your platelet count, bleeding symptoms, and overall health. Many people, especially children, do not need treatment because ITP gets better on its own. For adults or those with bleeding, doctors may recommend treatments to raise platelet levels or control the immune system. No medication names or doses are given here – your doctor will discuss the best options for you.

Self-care at home

• Avoid activities that could cause injury, such as contact sports or heavy lifting, while your platelet count is low.
• Use a soft toothbrush to prevent gum bleeding.
• Avoid over-the-counter pain relievers like aspirin or ibuprofen – these can increase bleeding risk.
• Apply firm pressure to any cuts or nosebleeds for at least 10–15 minutes without checking.

Medical treatments

If treatment is needed, your doctor may recommend medicines that help your immune system stop attacking platelets, or treatments that increase platelet production. Corticosteroids (like prednisone) are often used first. Other options include intravenous immunoglobulin (IVIG) – immune proteins given through a drip – or medications that boost platelet production. These treatments are given in hospital or clinic. Your doctor will discuss the risks and benefits of each option. Surgery to remove the spleen (splenectomy) is rarely used today but may be considered if other treatments do not work.

When is surgery considered?

Splenectomy – removal of the spleen – is sometimes used when ITP does not respond to other treatments. The spleen is where platelets are destroyed. Surgery is usually effective, but it increases the risk of serious infections, so you will need vaccines and possibly lifelong antibiotics. This is not the first choice and is discussed carefully with your haematologist.

Living with this condition

Living with ITP often means being aware of your platelet count and adjusting activities to avoid injury. Most people with ITP can work, go to school, and enjoy normal daily life. You may need regular blood tests and doctor visits, especially when your platelets are low. With good communication with your healthcare team, you can manage ITP well.

Lifestyle tips

• Wear a medic alert bracelet or carry a card stating you have a bleeding disorder – this helps emergency workers give the right care.
• Get all recommended vaccines to protect against infections – especially flu, pneumonia, and COVID-19 (talk to your doctor about timing if you are on immune-suppressing treatment).
• Avoid heavy lifting, contact sports, and rough play during low platelet periods.
• Use caution with sharp objects like knives or scissors.

Diet and exercise

No special diet is needed for ITP, but eating a balanced diet rich in fruits, vegetables, and lean protein supports overall health. Gentle exercise like walking or yoga is usually safe, but avoid high-impact sports until your platelet count is stable. Always ask your doctor what activities are right for you.

Mental health and emotional wellbeing

Living with a chronic bleeding disorder can be stressful. You may feel anxious about bleeding or frustrated with frequent doctor visits. It is normal to worry, but you do not have to face it alone. Talk to your doctor about your feelings – they can offer support or refer you to a counselor. If you feel very sad or hopeless, please reach out to a mental health provider or crisis support.

Prevention

There is no known way to prevent ITP because it is an autoimmune condition. However, you can reduce the risk of complications by managing symptoms early and avoiding injuries when your platelets are low. Vaccines against viral infections may lower the chance of some triggers.

Vaccines

Getting routine vaccines, such as flu, pneumonia, and COVID-19, is recommended. Some vaccines (like MMR) use live viruses and may need to be delayed if you are on certain treatments – discuss with your doctor. There is no vaccine to prevent ITP itself.

Screening programmes

There is no routine screening for ITP. It is usually found when someone has symptoms or when a blood test done for another reason shows low platelets. If you have a family history of ITP or autoimmune disorders, you may want to discuss monitoring with your doctor.

Complications

If left untreated

• Increased risk of severe bleeding, including internal bleeding in the brain or digestive tract – this is rare but serious.
• Ongoing bleeding that can lead to anaemia (low red blood cells), causing fatigue and weakness.
• Bleeding after injury or surgery can be harder to control.
• In pregnancy, ITP can affect both mother and baby, increasing the risk of bleeding during delivery.

Long-term outlook

The outlook for ITP is generally very good. In children, about 80% recover completely within months, often without any treatment. In adults, ITP can become a long-term condition, but with proper treatment most people can maintain a good quality of life and low risk of serious bleeding. Even if ITP does not go away completely, symptoms can usually be managed well. Your healthcare team will work with you to find the best plan.

Find support

International organisations

• Platelet Disorder Support Association (PDSA) ↗
• ITP Support Association ↗

Local organisations

• NHS – Immune thrombocytopenia (ITP) information ↗ · United Kingdom

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