ITP overview

Overview

ITP (immune thrombocytopenia) is a condition where your immune system mistakenly attacks and destroys platelets, which are tiny blood cells that help your blood clot. This can lead to easy bruising and bleeding.

ITP is considered a rare disorder, affecting about 1 in 10,000 to 1 in 30,000 people each year. However, it is one of the most common bleeding disorders.

ITP can affect anyone, but it is most often seen in children (especially after a viral infection) and in adults under the age of 40. Women are slightly more likely to develop ITP than men.

Symptoms

Common symptoms

• Easy or excessive bruising (purpura) – purple, red or brown spots on the skin
• Petechiae – tiny red or purple dots on the skin, often on the legs
• Nosebleeds that are hard to stop
• Bleeding from the gums when brushing teeth
• Heavy menstrual periods
• Blood in urine or stool (may look dark or tarry)

Symptoms in children

• Often appears suddenly after a viral infection (like chickenpox or flu)
• Symptoms are usually mild and may go away on their own within a few months
• Bruising and petechiae are common; serious bleeding is rare

Symptoms in older adults

• May develop more gradually than in children
• Bleeding symptoms can be more severe due to age and other health conditions
• May have a higher risk of internal bleeding if platelet counts are very low

Causes

Main causes

• The immune system produces antibodies that attack platelets, destroying them too quickly.
• In children, ITP often follows a viral infection, which triggers the immune system to attack platelets.
• In adults, the cause is often unknown, but it can be linked to other immune system conditions (like lupus) or some infections (like HIV, hepatitis C, or H. pylori).

Risk factors

• Recent viral infection (especially in children)
• Having another autoimmune disease (like lupus or antiphospholipid syndrome)
• Certain infections (HIV, hepatitis C, H. pylori)
• Female sex (slightly higher risk in adults)

When to see a doctor

See a doctor urgently if:

• You have a sudden, severe headache that is different from usual headaches
• You notice blood in your urine or stool
• You have a serious injury or a fall, especially if you hit your head
• You have a nosebleed that does not stop after 20 minutes of pressure

Book a routine appointment if:

• You develop unexplained bruising or tiny red spots (petechiae) that don’t go away
• You have frequent or heavy nosebleeds or gum bleeding
• You feel unusually tired or weak
• You have heavy menstrual periods that cause you to feel dizzy or short of breath

Diagnosis

Your doctor will review your symptoms and medical history, do a physical exam, and order blood tests. The main test is a complete blood count (CBC) to check your platelet level. Other tests may be done to rule out other causes of low platelets.

Tests that may be done

• Complete blood count (CBC) to measure platelet count and other blood cell levels
• Peripheral blood smear – a sample of your blood is looked at under a microscope to check platelet size and shape
• Bone marrow test (aspiration or biopsy) – sometimes needed to see if your bone marrow is making enough platelets (usually only if the diagnosis is not clear or if other conditions are suspected)
• Tests for infections or autoimmune conditions (e.g., HIV, hepatitis, lupus)

What to expect at your appointment

Diagnosis can take a few days to a few weeks. Your doctor will explain the results and what they mean. If ITP is confirmed, you will be referred to a hematologist (a blood specialist) for further management.

Treatment

Treatment for ITP depends on how low your platelet count is, whether you have bleeding symptoms, and what caused the condition. Many people with mild ITP may not need any treatment, just monitoring. If treatment is needed, it aims to raise platelet counts to a safe level to prevent bleeding, and to manage any underlying triggers.

Self-care at home

• Avoid activities that could cause injury or bruising (like contact sports) until platelet counts are safe
• Use a soft toothbrush to prevent gum bleeding
• Avoid heavy lifting or straining that could cause bleeding
• Tell all your healthcare providers (including dentists) that you have ITP before any procedures
• Wear a seatbelt in the car to reduce injury risk

Medical treatments

Your doctor may recommend treatments such as medicines that help your immune system stop attacking platelets, or treatments that help your body make more platelets. In some cases, a therapy called 'removal of the spleen' (splenectomy) may be considered if other treatments do not work. Your healthcare team will explain the options and help you choose what is best for you.

When is surgery considered?

Surgery to remove the spleen (splenectomy) is sometimes used for chronic severe ITP that does not respond to other treatments. It is not the first choice. Your doctor will only recommend it if absolutely needed.

Living with this condition

Most people with ITP lead normal lives. You may need to take some precautions to avoid injury and bleeding. You will have regular blood tests to check your platelet count. Your doctor will tell you how often you need to be checked based on your platelet levels.

Lifestyle tips

• Avoid contact sports or activities with a high risk of falling or injury
• Be careful with sharp objects (like knives and scissors)
• Wear protective gear for activities like cycling or skiing
• Limit alcohol intake, as alcohol can affect platelet function

Diet and exercise

There is no special diet for ITP, but it's important to eat a healthy, balanced diet to support your overall health. Gentle exercise like walking, swimming, or yoga is usually fine, but avoid intense or risky activities. Always check with your doctor before starting a new exercise routine.

Mental health and emotional wellbeing

Living with a chronic condition can be stressful. It is normal to feel anxious or worried about bleeding risks. Talk to your healthcare provider about any emotional concerns; they can offer support or refer you to a counselor. Remember that most people with ITP manage well with proper care.

Prevention

In most cases, ITP cannot be prevented because it is caused by the immune system reacting in an unexpected way. However, managing any underlying conditions (like infections) may reduce the risk of ITP related to those causes.

Vaccines

Some vaccines (like the MMR vaccine) have been linked to a very small risk of ITP. But the benefits of vaccines far outweigh the risks. Talk to your doctor about vaccinations if you have ITP.

Screening programmes

Screening for ITP in people without symptoms is not recommended. It usually comes to light when a routine blood test shows low platelets or when symptoms occur.

Complications

If left untreated

• Increased risk of serious bleeding, including internal bleeding (especially in the brain)
• Chronic low platelet count that lasts for months or years
• Bleeding after injury or surgery that is hard to control

Long-term outlook

The outlook for ITP is generally good. In children, ITP often resolves on its own within three to six months. In adults, it may become chronic, but with proper treatment and monitoring, most people can lead active, full lives. Serious complications are rare with good medical care.

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