Signs and Symptoms of ITP

ITP can occur with no symptoms, according to the Mayo Clinic.

Symptoms may begin to appear when platelet levels are very low. According to the National Organization for Rare Disorders (NORD), symptoms of ITP can include:

Bruising or purple spots on the skin that occur very easily or for no known reason
Small red dots that resemble a rash
Frequent nosebleeds
Bleeding from the gums
Unusually long or heavy menstrual bleeding
Hematoma, or a pooling of clotted or partially clotted blood under the skin. A hematoma can cause pain and swelling.
Blood in urine, stool, or vomit

Learn more about symptoms of ITP.

Causes and Risk Factors of ITP

According to the Cleveland Clinic, ITP is usually the result of an autoimmune response, in which the immune system accidentally attacks itself.

When this happens, platelets get destroyed by mistake.

While it’s not entirely understood why this happens, ITP may be linked to certain infections, such as HIV, hepatitis C, or Helicobacter pylori (H. pylori), a type of bacteria that causes stomach ulcers, according to the Mayo Clinic.

Children usually get short-term ITP, which is often triggered by a viral infection, according to the Cleveland Clinic.

Women are more likely to get ITP than men.

How Is ITP Diagnosed?

To diagnose ITP, your doctor will take a full medical history and perform a physical exam, looking for signs of bleeding and bruising. Other potential causes of low platelet count, such as certain medication or an underlying illness, will need to be ruled out, according to the Mayo Clinic.

Certain blood tests can check your platelet count. According to the Cleveland Clinic, these include:

A complete blood count, which checks your number of white blood cells, red blood cells, and platelets
A blood smear, in which your blood is put on a slide and a doctor checks your platelet levels

In rare cases, a bone marrow test may also be performed to check if your bone marrow is making enough platelets. Your doctor may also screen you for HIV, hepatitis C, or H. pylori. They may also order an anti-platelet antibody test, yet the accuracy of these tests varies.

Duration of ITP

There are two types of ITP: acute and chronic. Acute ITP is more common in children between the ages of 2 and 6 years old. The condition occurs very suddenly, and may appear after a viral illness like the chicken pox. Acute ITP typically goes away within a few weeks or months, according to the Cleveland Clinic.

Many children will not require treatment and the disorder usually does not recur.

Chronic ITP is more common in adults, although it can also happen in children. Symptoms can last from 6 months to several years and the condition can recur often, according to the Mayo Clinic.

Your doctor will discuss with you the best course of treatment and any follow-up necessary to help manage the condition.

Treatment and Medication Options for ITP

There is no cure for ITP, but there are effective ways to manage it. One of these strategies is to use medication. These may include:

Treatment with an oral corticosteroid, such as prednisone, dexamethasone, or methylprednisolone, is usually the first line of treatment for ITP, according to the National Organization for Rare Diseases (NORD).
These drugs can get your platelets back to safe levels but are only recommended for short-term use, as they can increase your risk of a number of health conditions, including high blood pressure, infections, and osteoporosis, according to the Mayo Clinic.
Immune Globulin If your body doesn’t respond to corticosteroids, your doctor may recommend immune globulin. According to NORD, this medication is administered through an IV on an as-needed basis, usually two to four weeks.
Immune globulin can be used in an emergency if you have critical bleeding or need to up your platelet levels right away, according to the Mayo Clinic.
Drugs to Raise Platelet Count Certain medication can boost platelet production, including Nplate (romiplostim), Promacta (eltrombopag), and Rituxan and Truxima (rituximab), according to the Mayo Clinic.

In severe cases of ITP or when there is little response to medication therapy, surgery to remove the spleen may be needed. This procedure is called a splenectomy.

The spleen is an organ responsible for making antibodies that fight infections. When an individual has ITP, these antibodies attack platelets by mistake. Removing the spleen may help get platelets back to a normal level, although effectiveness is variable and estimated to be 50 to 70 percent compared with nonsurgical treatment.

However, there are risks associated with this procedure, as not having a spleen can increase the risk of infection, according to the Cleveland Clinic.

If you and your doctor decide a splenectomy if the best course of action, you may be given vaccines before the procedure to prevent infection.

Learn more about treatment for ITP.

Prevention of ITP

There is no known way to prevent ITP, according to the Cleveland Clinic, but there are steps you can take to prevent complications.

These include avoiding medicines that can increase the risk of bleeding, such as ibuprofen and aspirin. Always talk to your doctor before starting any new medication or supplement.

Avoid contact sports that can lead to head injuries, such as boxing, football, and karate. Generally, swimming, cycling with a helmet, and walking are considered safe forms of physical activity.

If you have any signs of an infection, especially a fever, call your doctor right away. Getting prompt treatment can help prevent complications.

Complications of ITP

The biggest and most worrisome complication associated with ITP is bleeding in the brain, according to the Mayo Clinic.

This can be fatal. However, it is very rare.

Excessive bleeding during pregnancy can also be a problem for women with ITP. If you’re pregnant and your platelet count is very low, your doctor may recommend treatment to prevent heavy bleeding, according to the Mayo Clinic.

ITP can also affect mental and emotional health, as well as overall quality of life. Symptoms like unexplained bruising may lead to embarrassment and social isolation, according to NORD. This may also be accompanied by depression and anxiety. Additionally, debilitating fatigue affects 39 percent of adults with ITP, the organization reports.

Related Conditions and Causes of ITP

ITP is linked to a number of infections, including HIV, hepatitis C, and H. pylori.

HIV, or the human immunodeficiency virus, is a virus that attacks the body’s immune system and if left untreated, leads to AIDS. According to the Centers for Disease Control and Prevention (CDC), an estimated 1,189,700 people in the United States were living with HIV by the end of 2019.

There is no cure for HIV, but thanks to advancements in medicine, people with HIV can go on to live full, healthy lives with treatment.

Hepatits C is a virus that affects the liver and is spread from person to person through contact with blood, according to the CDC.

The most common form of transmission today is sharing needles to inject drugs. People with hepatitis C may not have symptoms until their condition has progressed to advanced liver disease. Complications can be serious and include cirrhosis and liver cancer. However, hepatitis C can be cured. According to the CDC, more than 90 percent of cases can be cured within two to three months of oral therapy.

H. pylori is a bacteria that leads to an infection in the stomach that leads to peptic ulcers. Treatment of this infection in patients with ITP is associated with an increase in platelet count, yet the mechanisms are not fully understood. According to the Mayo Clinic, it’s estimated that half the world’s population has H. pylori present in their bodies.

However, many people will never get sick. If you do have symptoms of an H. pylori infection, such as abdominal pain that feels like a burning sensation and worsens when your stomach is empty, nausea, bloating, loss of appetite, and frequent burning, see your doctor. The infection can be treated with antibiotics.

ITP and COVID-19

ITP can be triggered by viral infections, including COVID-19, as documented by a French study published in August 2020 in the British Journal of Haematology.

Viral infections like COVID-19 can also exacerbate symptoms in people with ITP. The American Society of Hematology recommends patients with ITP limit visits to medical centers to reduce the risk of infection and attend virtual appointments when possible.

Individuals with ITP should follow public health guidance on measures to prevent infection with COVID-19.

Learn more about COVID-19.

Editorial Sources and Fact-Checking

Immune Thrombocytopenia. Medline Plus. August 18, 2020.
Immune Thrombocytopenia. Cleveland Clinic.
Immune Thrombocytopenia (ITP). Mayo Clinic. February 25, 2021.
Immune Thrombocytopenia. National Organization for Rare Disorders.
HIV Basics. Centers for Disease Control and Prevention. August 4, 2021.
Viral Hepatits. Centers for Disease Control and Prevention. July 28, 2020.
Screen All Patients for Hepatitis C. Centers for Disease Control and Prevention. June 14, 2021.
Helicobacter pylori (H. pylori) Infection. Mayo Clinic. May 18, 2021.
Mahevas M, Moulis G, Andres E, et al. Clinical Characteristics, Management and Outcome of COVID-19-Associated Immune Thrombocytopenia: A French Multicentre Series. British Journal of Haematology. July 17, 2020.
COVID:19 and ITP: Frequently Asked Questions. The American Society of Hematology. April 21, 2021.

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