What Are the Signs and Symptoms of Immune Thrombocytopenia?


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Immune thrombocytopenia (ITP) may not cause any signs or symptoms. However, ITP can cause bleeding inside the body or underneath or from the skin. Signs of bleeding may include:

  • Bruising or purplish areas on the skin or mucous membranes (such as in the mouth). These bruises are called purpura. They’re caused by bleeding under the skin, and they may occur for no known reason.
  • Pinpoint red spots on the skin called petechiae. These spots often are found in groups and may look like a rash. Bleeding under the skin causes petechiae.
  • A collection of clotted or partially clotted blood under the skin that looks or feels like a lump. This is called a hematoma.
  • Nosebleeds or bleeding from the gums (for example, during dental work).
  • Blood in the urine or stool.

Any kind of bleeding that’s hard to stop could be a sign of ITP. This includes menstrual bleeding that’s heavier than normal. Bleeding in the brain is rare, and its symptoms may vary.

A low platelet count doesn’t directly cause pain, problems concentrating, or other symptoms. However, a low platelet count might be associated with fatigue.  

How Is Immune Thrombocytopenia Treated?

Treatment for immune thrombocytopenia (ITP) is based on how much and how often you’re bleeding and your platelet count.

Adults who have mild ITP may not need any treatment, other than watching their symptoms and platelet counts. Adults who have ITP with very low platelet counts or bleeding problems often are treated.

The acute type of ITP that occurs in children often goes away within a few weeks or months. Children who have bleeding symptoms, other than merely bruising (purpura), usually are treated.

Children who have mild ITP may not need treatment other than monitoring and follow-up to make sure their platelet counts return to normal.

Medicines

Medicines often are used as the first course of treatment for both children and adults.

Corticosteroids, such as prednisone, are commonly used to treat ITP.

Other medicines also are used to raise the platelet count. Some are given through a needle inserted into a vein. These medicines include rituximab, immune globulin, and anti-Rh (D) immunoglobulin.

Medicines also may be used with a splenectomy.

If medicines or splenectomy don’t help, two newer medicines—eltrombopag and romiplostim—can be used to treat ITP.

Removal of the Spleen (Splenectomy)

If needed, doctors can surgically remove the spleen. This organ is located in the upper left abdomen. The spleen is about the size of a golf ball in children and a baseball in adults.

The spleen makes antibodies (proteins) that help fight infections. In ITP, these antibodies destroy platelets by mistake.

If ITP hasn’t responded to medicines, removing the spleen will reduce the destruction of platelets. However, it also may raise your risk for infections. Before you have the surgery, your doctor may give you vaccines to help prevent infections.

If your spleen is removed, your doctor will explain what steps you can take to help avoid infections and what symptoms to watch for.

Other Treatments

Platelet Transfusions

Some people who have ITP with severe bleeding may need to have platelet transfusions and be hospitalized. Some people will need platelet transfusions before having surgery.

For a platelet transfusion, donor platelets from a blood bank are injected into the recipient’s bloodstream. This increases the platelet count for a short time.

For more information about platelet transfusions, go to the Health Topics Blood Transfusion article.

Treating Infections

Some infections can briefly lower your platelet count. Treating the infection may help increase your platelet count and reduce bleeding problems.

Stopping Medicines

Some medicines can lower your platelet count or cause bleeding. Stopping the medicine can sometimes help raise your platelet count or prevent bleeding.

For example, aspirin and ibuprofen are common medicines that increase the risk of bleeding. If you have ITP, your doctor may suggest that you avoid these medicines.