Idiopathic Thrombocytopenic Purpura
(Immune Thrombocytopenic Purpura; ITP)
Pronunciation: ID-ee-oh-PATH-ic Throm-boh-SIGH-toh-peen-ick Pur-PUR-ah
Idiopathic thrombocytopenic purpura (ITP) is a blood disorder. Antibodies produced in the spleen attack and destroy the body’s own blood clotting cells. These cells are called platelets. Platelets help stop bleeding. They travel to a damaged area of the body and stick together. This forms a sort of barrier against germs. It becomes difficult to stop bleeding from injuries if there are not enough platelets in the body.
Although people with ITP have a lower than normal number of platelets in their blood, all of their other blood cell counts are normal.
There are two types of ITP:
- Acute ITP—lasts less than six months. This type of ITP usually occurs in children. It is the most common type of ITP.
- Chronic ITP—lasts longer than six months. This type of ITP usually occurs in adults.
ITP is treatable. If you think you may have this disorder, contact your physician.
The cause of most cases of ITP is unknown.
In children, the disorder has been linked to a recent viral infection. It is believed that the immune system becomes confused. The confusion cause it to begin attacking healthy platelet cells. When too many platelets are destroyed, ITP can result. The disorder in adults has not been linked to viral infections.
Some cases of ITP are thought to be caused by drugs, infection, or other immune disorders.
Pregnant women sometimes develop the disorder.
The following factors increase your chances of developing ITP:
- Children with a recent viral infection or live virus vaccination (may sometimes put a child at a higher risk for developing ITP)
Women, usually younger than 40
- Women are 2-3 times more likely to get ITP than in men
If you experience any of the following, do not assume it is due to ITP. These may be caused by other, less serious health conditions. If you experience any one of them, see your doctor.
Both adults and children may notice the following symptoms:
- Easy bruising
- Dark urine or stools
- Bleeding for longer than normal following an injury
- Unexplained nosebleeds]]>
- Bleeding from the gums
- In adult women, heavier-than-normal menstrual periods
Red dots called petechiae on the skin
- Petechiae may occur in groups and resemble a rash.
- In rare cases: bleeding within the intestinal tract or brain
Your doctor will ask about your symptoms and medical history. A physical exam will be done.
Tests may include the following:
- Complete blood count (CBC)—A blood sample is tested to see if the numbers of different blood cells are normal.
- Bone marrow test]]> —A needle is inserted in the skin and into the bone. A small amount of bone marrow is removed. It is tested to be sure there are normal numbers of platelet-producing cells in the marrow. This is done to rule out other disorders.
- ]]>CT scan]]> (in rare cases)—This is done if there is a concern about bleeding in the brain.
Treatment for ITP is different for children and adults. Talk with your doctor about the best plan for you.
Most children recover from ITP without any treatment. However, your doctor may recommend the following treatments:
To increase platelet counts in the blood:
- Steroids (eg, Prednisone]]> )—lowers the activity of the immune system. This keep its from destroying platelets.
- Gamma globulin infusions—are an antibody-containing protein that slows down platelet destruction. An infusion means that it is given by IV (into vein) or through a shot. It usually works more quickly than steroids.
Both of these treatments work but both can have side effects. Eighty-five percent of children who have ITP recover within a year and do not experience the problem again.
Two new drugs to stimulate platelet production:
Use of these and also of targeted monoclonal antibody ]]>rituximab]]> (Rituxan) may prevent the need for splenectomy.
In adults, if drug intervention does not do enough to raise platelet counts, the doctor may recommend a ]]>splenectomy]]> .
Splenectomy is the surgical removal of the spleen. This procedure stops the destruction of platelets since the antibodies are made in the spleen. It also leaves the body more vulnerable to infection from other sources. This surgery is usually not performed until the medications have proven ineffective.
Doctors sometimes recommend lifestyle changes. This may include avoiding contact sports or wearing a helmet, when platelet counts are low.
Since the cause of ITP is unknown, there are no specific ways of preventing it. However, bleeding and injury can be serious for people with ITP.
- Take precautions such as padding an infant's crib or play area.
- Make sure that older children wear helmets and protective gear when playing sports. This will help to reduce bruising injuries.
- When platelet counts are low, contact sports such as football and even rougher game playing may have to be stopped temporarily.
- People who have ITP should also avoid medications that contain aspirin]]> or ]]>ibuprofen]]> . These medicines can reduce platelet function.
To help stay healthy, you should:
- Eat a ]]>healthful diet]]> . It should be low in saturated fat and rich in whole grains, fruits, and vegetables.
- Get regular ]]>exercise]]> .
- If you are overweight, ]]>lose weight]]> .
- Don’t smoke. If you smoke, ]]>quit]]> .
- Drink alcohol only in moderation. Moderate alcohol intake is two drinks per day for men and one drink per day for women.
American Academy of Family Physicians
National Heart, Lung, and Blood Institute
National Institute of Diabetes and Digestive and Kidney Diseases
Canadian Medical Association Journal
Bussel JB; Cheng G; Saleh MN; Psaila B; Kovaleva L; Meddeb B; Kloczko J; Hassani H; Mayer B; Stone NL; Arning M; Provan D; Jenkins JM. Eltrombopag for the treatment of chronic idiopathic thrombocytopenic purpura. N Engl J Med . 2007 Nov 29;357(22):2237-47.
George JN, Woolf SH, Raskob GE, et al. Idiopathic thrombocytopenic purpura: a practice guideline developed by explicit methods for The American Society of Hematology. American Society of Hematology website. Available at: http://www.hematology.org/practice/idiopathic.cfm . Accessed Dec 12, 2006.
Newland A; Caulier MT; Kappers-Klunne M; Schipperus MR; Lefrere F; Zwaginga JJ; Christal J; Chen CF; Nichol JL. An open-label, unit dose-finding study of AMG 531, a novel thrombopoiesis-stimulating peptibody, in patients with immune thrombocytopenic purpura. Br J Haematol . 2006 Nov;135(4):547-53.
Karpatkin S. Autoimmune (idiopathic) thrombocytopenic purpura. Lancet . 1997;349:1531-1536.
Last reviewed January 2009 by ]]>Igor Puzanov, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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