What is ITP?
What is ITP? Immune thrombocytopenia (ITP) is a disorder related to low levels of platelets in the body that may lead to easy or excessive bleeding and bruising.
There are two types of ITP, including:
- Acute thrombocytopenic purpura. This is the most common type of ITP and typically affects children between the ages of 2 and 6. Symptoms usually start suddenly after a viral infection and disappear within six months (commonly within a couple of weeks) and usually do not recur.
- Chronic thrombocytopenic purpura. This type of ITP can occur at any age; however, it affects adults more often than children. Symptoms last for a minimum of six months, but may persist for years or even continue throughout the lifespan. Chronic ITP does recur and requires continual care with a specialist.
Causes of ITP
Immune thrombocytopenia typically happens when the immune system mistakenly attacks and destroys the platelets in the body. In rare cases, a type of white blood cell (T-cells) directly attacks the platelets. In adults, ITP may be triggered by various factors, including:
- Certain infections (i.e., hepatitis, HIV, or H. pylori)
- Medications – can cause an allergy that interacts with platelets
- Autoimmune disorders (i.e., lupus, rheumatoid arthritis, etc.)
- Low-grade leukemias and lymphomas, as they can produce abnormal antibodies that act against platelets
In children, ITP is usually triggered by a viral infection, including chickenpox, flu, or mumps. In some cases, the underlying cause of ITP is unknown.
Risk Factors for ITP
Various risk factors have been identified which increase the risk of developing ITP, including:
- Being a younger female, as ITP affects women two to three times more often than men.
- Having certain diseases, including lupus, rheumatoid arthritis, and antiphospholipid syndrome.
Symptoms of ITP
In some cases, individuals with ITP have no signs or symptoms. However, when symptoms do occur, the following may be experienced:
- Easy or excessive bruising
- Pinpoint reddish-purple spots on the skin that look like a rash (petechia), most commonly on the lower legs
- Nose bleeds
- Bleeding gums
- Blood in the stool or urine
- Heavy menstrual flow
Complications of ITP
Rarely, bleeding into the brain that can be fatal, can occur in individuals with ITP.
Also, women who are pregnant and have a low platelet count have an increased risk of heavy bleeding during labor and delivery. Treatment should focus on maintaining a healthy platelet count, while taking into account treatment effects on the baby.
Treatment of ITP
Treatment for ITP is based on various factors, including:
- Age, overall health, and previous health history
- Disease severity
- Tolerance for certain medications, therapies, and/or surgeries
- Patient preference
Adults who have mild ITP may only need regular monitoring and platelet checks. However, most adults with ITP eventually require treatment as the condition usually becomes chronic or severe. Treatment may involve various options, including:
Medications to Treat ITP
- Steroids. Oral corticosteroids (i.e., prednisone) may be used initially to get platelet counts to a healthy level. Once platelet levels are stabilized steroids should be slowly discontinued as long-term steroid use has been linked to a number of adverse health effects including an increased risk of infection, osteoporosis, and high blood sugar.
- Immune globulin. In cases that do not respond to steroids, an injection of immune globulin may be recommended. Additionally, immune globulin may be used in cases of severe bleeding or when blood counts need to be increased prior to surgery. Treatment effects of immune globulin typically dissipate in a couple of weeks.
- Platelet production medications. These medications, including romiplostim and eltrombopag, encourage platelet production in the bone marrow. However, these medications increase the risk of blood clots.
- Monoclonal antibody medications. These medications, including rituximab, work by decreasing the immune system response, which helps to protect the platelets. However, these medications reduce vaccine effectiveness.
Severe cases that do not respond to traditional drug therapy may require surgery to remove the spleen (splenectomy). This procedure usually increases platelet count, but it does not work for every case. Additionally, removing the spleen increases the risk of infection.
In rare cases, severe bleeding may occur and is typically treated with platelet concentrate transfusion as well as intravenous steroids and immune globulin.
An important part of the treatment plan is to avoid medications that may inhibit normal platelet functioning, including ibuprofen, aspirin, and ginkgo biloba.
Children with this condition usually improve without treatment, with platelet levels often returning to normal within 6 to 12 months in most cases. Rarely, ITP in children does not go away and requires further medical treatment.
In addition to medicinal and surgical treatment options, there are also lifestyle factors that can be modified to help control the condition, including:
- Don’t participate in contact sports as they increase the risk of bleeding.
- Use appropriate protective gear when participating in risky activities/sports (i.e., helmets, knee pads, etc.).
- Be aware of signs of infection, such as fever, particularly after splenectomy.
Immune thrombocytopenia is a relatively common disorder that causes a decrease in platelets, often leading to easy and excessive bleeding and bruising. While children affected by this usually improve without treatment, adults often require treatment with medications, lifestyle factor modifications, and in some cases, surgery.