Immune thrombocytopenic purpura (ITP)

Right now, you probably have a lot of questions about ITP. How dangerous is this condition? What is the very best treatment? What do we do next?

We’ve tried to provide some answers to those questions in the following pages, and our expert pediatric subspecialists can explain your child’s condition fully when you meet with us.

What is immune thrombocytopenic purpura?

Immune thrombocytopenic purpura (ITP) is an autoimmune disorder (meaning the immune system attacks the body’s own tissues) that occurs when the body destroys its platelets, a part of the blood that helps control bleeding by forming blood clots. ITP often occurs following a viral infection.

• In healthy children, the body produces proteins called antibodies that guard against infection.
   
• ITP causes a child’s body to make abnormal antibodies that stick to platelets, which the spleen (the organ that helps filter infections in the blood) recognizes as signs of infection and destroys. This causes the bone marrow to respond by producing more platelets.
   
• In a child with ITP, the body is therefore producing platelets normally, but it is also destroying them too quickly, with platelets surviving only a few hours instead of the normal seven to 10 days.
   
• The end result is a low platelet count in the blood.

What causes ITP?

In most cases, the underlying cause of ITP is not completely known.

• Often, a child may have had a viral infection a few weeks before developing symptoms of ITP.
   
• Viral infections may trigger ITP because the antibodies the body develops to fight them can also attack platelets.
   
• ITP is not contagious, meaning your child cannot catch it from playing with another child who has ITP.

Types of immune thrombocytopenic purpura

Acute thrombocytopenic purpura:

• most common form of Immune thrombocytopenic purpura
• usually occurs in children, ages 2 to 6
• symptoms may follow a viral infection
• sudden onset, with symptoms disappearing in less than six months and often within a few weeks
• usually does not recur after the child gets better
• risk of serious or life-threatening bleeding is very low

Chronic thrombocytopenic purpura:

• more common in adults but can occur in children
• affects girls two to three times more often than boys
• symptoms last a minimum of six months and can persist for many years
• may become a lifelong problem
• regular follow-up care with a blood specialist (hematologist) is recommended

Is immune thrombocytopenic purpura common?

Yes, ITP affects at least 3,000 children under the age of 16 each year in the United States.

What are the symptoms of immune thrombocytopenic purpura?

The most common symptoms of ITP are: 

• purpura (purple color of the skin after blood has leaked under it forming a bruise, often from no known trauma)
• petechiae (tiny red dots under the skin that are the result of very small bleeds into the skin)
• nosebleeds
• bleeding from the mouth
• blood in vomit, urine or stool
• in rare cases, bleeding inside the head (most dangerous symptom that can be life-threatening, usually prompted by head trauma)

FAQ

Q: Will my child be OK?

A: Many children with ITP get better on their own over days, weeks or sometimes months. In other cases, medications may be required in order to alleviate the symptoms of ITP. Your child will require blood tests to monitor platelet levels and will need follow-up care until the ITP resolves. The outlook for children with ITP is very positive and severe complications are rare.

Q: What is a platelet count? What do my child’s platelet count results mean?

A: A platelet count is a blood test that is part of a complete blood count (CBC) and determines the average number of platelets in your child’s blood.

A normal person has a platelet count of 150,000 to 450,000. With ITP, a child has a platelet count of less then 100,000. Children are at risk for significant bleeding when they have a platelet count of less than 10,000. The lower the platelet count, the greater the risk of bleeding.

Q: What is the risk of serious bleeding?

A: The risk of serious or life-threatening bleeding is very low. Less than one in one hundred patients with ITP will experience this complication. Your child’s physician will monitor your child’s platelet levels in order to reduce the risk of bleeding. In addition, your child’s physician may recommend that your child limit physical activity if his platelet count is too low.

Q: Can my child participate in sports or other athletic activities?

A: The sports and activities that your child can participate in will depend on your child’s platelet count (the severity of the ITP). Your child’s physician will make specific recommendations on the types of activities that may be appropriate for your child depending on his platelet levels. For more information on ITP and sports, visit our ITP website: www.itpkids.org.

Q: Where will my child be treated?

A: Children will receive care in our hematology clinic on the sixth floor of the Fegan building. For many appointments and certain procedures, your child can also receive care at one of our satellite offices.

Q: What services are available to help my child and my family cope?

A: We offer a variety of support services to help you, your child and your family.

Questions to ask your doctor

You and your family are key players in your child’s medical care. It’s important that you share your observations and ideas with your child’s health care provider and that you understand your provider’s recommendations.

You probably already have some ideas and questions on your mind, but it can be easy to forget the questions you wanted to ask when you’re talking to your child’s doctor. It’s often helpful to jot them down ahead of time so to make sure that all of your concerns have been addressed.

If your child is old enough, you may want to suggest that she write down what she wants to ask her health care provider, too.

Some of the questions you may want to ask include:

• How severe is my child’s ITP?
• What is my child’s platelet count and what does this number mean?
• What symptoms might my child experience?
• How will my child’s symptoms be managed?
• What are the potential complications? How can I help my child avoid them and recognize them if they do occur?
• How often will my child need to come in for follow-up care?
• How can I make my child safer?
• Can my child play sports?
• Will my child be affected long-term?