Immune Thrombocytopenia (ITP)

These instructions for Children's Hospital of Philadelphia (CHOP) patients describe immune thrombocytopenia, where the immune system mistakenly attacks platelets, the blood cells needed to stop bleeding.

Important information about thrombocytopenia:

Platelets are blood cells, made in the bone marrow, that are very important to help form blood clots. Clots prevent or stop the body from bleeding. When the platelet count is low, it is called thrombocytopenia. When platelet counts are low, there is a risk for bleeding. When they are extremely low, there is a risk for spontaneous bleeding which means bleeding without a cause or injury.

Thrombocytopenia can be:

• Mild - a platelet count between 75,000-150,000/µL

• Moderate - a platelet count between 20,000-75,000/µL

• Severe - a platelet count

What is immune thrombocytopenia (ITP)?

Immune thrombocytopenia happens when the body's immune system mistakenly attacks and destroys platelets causing thrombocytopenia. Specifically, the immune system creates antibodies against the platelets.

What causes immune thrombocytopenia?

• A viral illness

• Some types of medicines

• It can be found with other autoimmune diseases, like lupus

• Rarely, there is an underlying problem with the immune system

• Sometimes the cause cannot be found

What are symptoms of immune thrombocytopenia?

• Bruising

• Petechiae, pronounced peh-TEE-kee-eye, which are tiny spots of bleeding under the skin. This can happen anywhere on the body, including in the mouth

• Bleeding, such as:

  • Nose bleeds

  • Bleeding gums from tooth brushing

  • Heavy or longer bleeding with periods (menses)

• Blood in urine or stool

• Some children will have fatigue or mild headaches

• Most children will have very few symptoms

• Very severe immune thrombocytopenia may increase the risk of bleeding in the brain and other vital organs

How is immune thrombocytopenia diagnosed?

A hematologist, a specialist for blood disorders, will be involved in your child's care. They will ask questions about your child's current illness, medical history and family history. They will decide if more blood tests are needed and look at the blood under the microscope. Your child may require more frequent bloodwork to monitor their blood counts.

How is immune thrombocytopenia treated?

Most children with immune thrombocytopenia will do well without medicines to raise the platelet count. They need careful observation and monitoring to keep them safe until the platelet count recovers.

If a medicine caused the ITP, it should be stopped. Your healthcare team will discuss different treatment options.

Sometimes medicine is given to raise the platelet count when there is too much bleeding. These medicines include:

• Corticosteroids may be used to calm the immune system, so it stops destroying the platelets. These can be given by IV or by mouth.

• Intravenous immunoglobulin (IVIG) can be used to decrease platelet destruction in the spleen.

• There are other medicines that may be used to help raise the platelet count.

Patient instructions:

• Encourage your child to participate in safe activities. Generally, contact sports should be avoided.

• Monitor your child for increased bruising, bleeding or changes in alertness. Contact your hematology team immediately for any symptoms.

• Discuss any new symptoms with your hematology team immediately, especially new headache or nausea and vomiting.

• Give your child all medicine exactly as prescribed. Do not stop any medicines early or give extra doses!

• Go to all scheduled lab draws and follow-up appointments. Please let your team know if you need help with work or other childcare arrangements.

• We understand that this is a stressful time for you and your child. The hematology team is here to help.

Please contact your CHOP hematology team with questions or concerns.

Division of Hematology

215-590-3535

For non-urgent issues, send your team a message in the MyCHOP portal.

>

Reviewed on July 23, 2023, by Diane Gardella, RN