Immune Thrombocytopenia (ITP)

What are the symptoms of immune thrombocytopenia?

There are two types of immune thrombocytopenia (ITP). Acute thrombocytopenia is the most common form of ITP — accounting for more than 90 percent of cases — and occurring between the ages of 2 and 6. The symptoms of acute thrombocytopenia:

• arise suddenly and usually disappear in less than six months, often within a few weeks
• usually do not recur after the child gets better

Chronic thrombocytopenia is more common in adults but can occur in children. The symptoms of chronic ITP:

• last a minimum of six months and can persist for many years.
• can require regular follow-up care with a hematologist (a doctor who specializes in blood disorders)

What causes ITP

While ITP in children often arises after a viral infection, for the majority of cases the cause is unknown. Luckily, acute ITP, the most common form, usually goes away on its own over the course of weeks or months, sometimes without treatment. Chronic ITP appears most frequently in adults, but occasionally is seen in children. This form of ITP is more serious, lasting for years and typically requiring specialized care.

How is immune thrombocytopenia diagnosed?

The first step in treating your child is forming an accurate and complete diagnosis. ITP can usually be identified by:

• a careful medical history
• physical examination
• complete blood count (CBC), including a hematologist’s examination of the blood under the microscope

After all tests are completed, doctors will be able to outline the best treatment options.

What are the treatment options for ITP

There are a number of treatments that can help increase platelet levels in children with immune thrombocytopenia (ITP), but there is no cure. The majority of children with ITP get better gradually on their own in a few days, weeks or sometimes months, with or without treatment.

When treatment is necessary, the most common forms are:

• steroids (usually prednisone) to temporarily reduce production of antibodies and increase platelet count by slowing the rate at which the spleen destroys them
• intravenous gamma globulin (also known as intravenous immunoglobulin, or IVIG), a human blood product containing antibodies that help slow the rate at which abnormal platelets are destroyed by the spleen
• intravenous Rho (D) immune globulin (also known as WinRho®), a human plasma product that temporarily stops the spleen from destroying platelets; children must be blood type Rh positive and still have their spleen to receive this treatment

Steroids

• temporarily reduce production of abnormal antibodies and increase platelet count by slowing the rate at which platelets are destroyed by the spleen
• may be taken orally
• side effects may include irritability, stomach irritation, weight gain, high blood pressure, acne or elevated levels of sugar in the urine

Intravenous gamma globulin (also known as intravenous immunoglobulin, or IVIG)

• a human blood product containing many antibodies that help slow the rate at which abnormal platelets are destroyed by the spleen
• given over three to six hours through a needle inserted into a vein
• temporary side effects include fever, chills, headache, muscle and joint pain, hives, rash or allergic reactions

Intravenous Rho (D) immune globulin (also known as WinRho®)

• temporarily stops the spleen from destroying platelets
• child must have Rh-positive blood and must still have their spleen in order for this medication to be effective
• given intravenously
• temporary side effects include: mild anemia, fever, chills, headache, blood pressure changes, or allergic reactions
• rarely, severe anemia from breakdown of blood cells can occur; this can possibly result in kidney damage

Other treatments for ITP

• surgery to remove spleen (splenectomy): considered more often in older children with chronic ITP
• 6-mercaptopurine (also called Purinethol or 6-MP): causes mild immune suppression, which helps to reduce platelet destruction.
• hormone therapy: for teenage girls, to stop their menstrual cycle if excessive bleeding occurs

Children with ITP also may receive antibiotics to treat infections.

What is the long-term outlook for children with ITP?

More than 80 percent of children with treated ITP recover on their own in days, weeks or months. Fatal brain hemorrhages rarely occur with steroid, intravenous Rh immune globulin or intravenous gamma globulin therapy.

Recurrence of ITP is uncommon, but it can occur up to several years after the initial episode and may be associated with another viral infection.

The sports and activities your child can participate in will depend on their platelet count (the severity of the ITP). Your child’s physician can make specific recommendations on the types of activities that may be appropriate, depending on their platelet levels. (Learn more about ITP and sports on our ITP Kids website.)

What is ITP?

ITP stands for immune thrombocytopenia — a decreased platelet number.

• You may also hear the term "idiopathic" thrombocytopenic purpura which was the older (historic) name for ITP. "Idiopathic" means the cause of the low platelets is unknown, but now we know that ITP is caused by problems in a person's immune system.
• ITP occurs when a person makes antiplatelet antibodies which attach to his/her own platelets. The antibodies cause the immune system to destroy the platelets. This results in a decrease in the platelet count.

What are platelets?

• Platelets are the blood cells that help form clots to stop bleeding.
• A blood test is done to count the number of platelets you have.
• A normal platelet count is higher than 100-150,000.
• Hematologists generally agree that platelet counts:
  • higher than 100,000 are always safe,
  • higher than 30,000 are nearly always safe, and
  • lower than 10,000 may be associated with an increased risk of bleeding.

How do you get ITP?

The cause of ITP is not known. ITP has been associated with:

• recent viral infection
• some medications
• immune disorders (including lupus)
• infections
• There is nothing you did to cause ITP.
• ITP is not contagious.
• There is no cure for ITP. Fortunately, most childhood cases resolve on their own.

Why would you treat ITP?

• The main reason to treat ITP is to decrease bleeding symptoms and/or to improve your quality of life.
• Platelet counts lower than 10,000 may increase the risk of bleeding.
• Therapy temporarily raises the platelet count to minimize the bleeding risk.

How is ITP treated?

There are a variety of treatment options for ITP. Treatment may include:

• observation only (regular monitoring of platelet counts and watching for bleeding symptoms)
• stopping medications that are thought to cause ITP
• treating infections

Other treatments also may be considered, including:

• steroids (usually prednisone)
• WinRho
• IVIG
• medicines that suppress the immune system
• Rituximab infusions
• medicines that help the body to make more platelets

These medications either trick the body's response so that it does not destroy the platelets or help the body to make more platelets. Physicians may also suggest other drug therapies that show promise for ITP.

In some instances a splenectomy (removal of the spleen) may be recommended.

How long does it take to treat ITP?

• Platelet counts may go up and down for many months.
• Childhood ITP usually resolves itself within 12 months.
• Some patients do not resolve within this period of time and continue with Chronic ITP.
• The chance of the ITP resolving is higher if a patient is younger at diagnosis and in patients with primary ITP (i.e, those without other autoimmune diagnoses or immunodeficiencies).
• The likelihood of ITP resolving is the same whether patients have been observed without treatment or have received treatment.

Playing sports is an important part of having fun and living your life. Having ITP should interfere as little as possible. Just keep in mind smart play such as wearing helmets, elbow pads, wrist guards and knee pads or any other protective equipment that is recommended for the sports you wish to play and try to avoid injury.

What sports can I play with ITP?

The following is a list of sports you can play or should avoid based on your platelet count. Just remember to have fun and be safe.
DISCLAIMER: There are no formal national guidelines for sports and activities with ITP. We've modeled these suggestions on those used by the National Hemophilia Foundation for other types of bleeding disorders.

Sports and outdoor activities can be pretty easily divided into three groups.

1. Sports that are safe for anyone, even with a bleeding disease. Walking, swimming, tennis are examples.
2. Everything else: basketball, soccer, baseball are examples.
3. Sports that are potentially dangerous for anyone, even without a bleeding disease. Hang gliding, tackle football, ski racing, wrestling are examples. For many patients, an important choice is whether it would be better to avoid some riskier contact sports, or to be treated to raise the platelet count in order to play. This question doesn't have a single best answer. It is important to consider this choice with your hematologist. The answer for one child may be quite different from the next. Always check with your hematologist if your platelet count is on the low end of any of these parameters for any serious sports playing. Normal platelet counts are >150,000/mm3. As long as your platelet count is over 75,000, it is usually safe to play most sports, just be sure to protect yourself as any athlete would.

If your platelet count falls below 75,000, it is best if you do NOT...

• play ice hockey with checking, field hockey (because of the sticks), or street hockey
• box
• dive competitively
• hang-glide
• play tackle football
• play rugby
• play lacrosse
• ride a motorcycle
• play racquetball (because of potential eye injury from racquets in close quarters)
• rock climb
• wrestle

If your platelet count is less than 75,000 but greater than 30,000 to 50,000, it is usually okay to...

• play baseball (just not catcher; wear a helmet on the bases)
• play basketball
• bowl
• dive in the pool (just no high dives or competitions)
• practice gymnastics
• horseback ride
• ice skate (wear a helmet if you're unsteady!)
• practice karate, Kung Fu or Tae Kwon Do (no kicks to the head!)
• mountain bike (wearing a helmet of course)
• go river rafting
• roller blade or roller skate (with protective equipment)
• run
• row
• skateboard (with protective equipment)
• cross country or downhill ski or snowboard (be sure to wear a helmet) Ski racing demands a higher platelet count.
• play soccer
• play tennis
• compete in track and field events
• play volleyball
• practice weight lifting

Most people with ITP can...

• water ski
• lift weights
• ride a bike (with a helmet of course)
• go fishing
• play frisbee
• play golf
• go for a hike
• practice Tai Chi or Karate
• go for a walk
• swim
• jog

Helpful links

• ITP diagnosis, research, and more
• Pediatric ITP Consortium of North America (ICON)
• Platelet Disorder and Support Association
• ITP Support Association
• The ITP Society
• National Heart Lung and Blood Institute
• Registry (UK)

ITP Staff at Dana-Farber/Boston Children's

• Rachael Grace, MD, Director
• Mary Holleran, PNP
• Loren D'Angelo, PNP
• Karyn Brundige, PNP
• Kristy McMillan, Registered Nurse
• Ashley Janes, Registered Nurse
• Kathryn Addonizio, Research Coordinator

Contact information

Boston Children's Hospital
300 Longwood Avenue
Boston, MA 02115

• Email: Kristy McMillan
• Phone: 617-355-8246
• Fax: 617-730-0641

The information on this website, including linked resources, should not be taken as medical advice, which can only be given to you by your personal health care professional. Specific treatment plans for any patient with ITP should be arranged after consultation with a physician experienced in this disorder for any given age group.

“ITP Kids” was created by Dana-Farber/Boston Children’s to help children and teens better understand ITP (immune thrombocytopenia) and options for managing and treating it.