Immune Thrombocytopenic Purpura

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KEY POINTS

• Immune thrombocytopenic purpura (ITP) is an autoimmune disease that causes problems with not having enough platelets. Unusual bleeding may happen inside the body or under the skin (bruising) when your child has a low platelet count.
• Treatment may include medicines, a platelet transfusion, or in rare cases, your child’s spleen may need to be removed.
• Your child should avoid contact sports such as football or soccer and other activities that are more likely to cause injuries. Your child should avoid injury by wearing a seat belt in a car or a helmet when on a bicycle or motorcycle.

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What is immune thrombocytopenic purpura?

Immune thrombocytopenic purpura (ITP) is an autoimmune disease. This means that the body's defenses against infection attack your child’s own healthy tissue. When your child has ITP, your child’s body attacks and destroys platelets. Platelets are the cell fragments in the blood that help form blood clots to stop bleeding. Your child may have unusual bleeding inside the body or under the skin (bruising) when your child has a low platelet count.

ITP is sometimes called idiopathic thrombocytopenic purpura.

What is the cause?

Both children and adults can get ITP. The cause is not clear.

ITP may happen after your child has had a viral infection such as the flu or the mumps, or if your child has a certain type of leukemia.

Your child’s risk of getting ITP may be increased if your child is between the ages of 2 and 4.

ITP is not contagious, which means your child can’t get sick from touching another person who has ITP.

What are the symptoms?

Symptoms may be mild. The main symptom is bleeding that lasts longer than normal after an injury or surgery such as:

• A lot of bruising or large bruises, even after minor injuries
• Tiny red or purple dots on the skin that may look like a rash
• Nosebleeds or gums that bleeding from gums
• Blood in bowel movements or urine
• Long or heavy menstrual periods in females
• Feeling very tired

How is it diagnosed?

Your healthcare provider will ask about:

• Your child’s symptoms
• Your child’s medical history
• All the medicines and supplements your child takes
• Foods and liquids your child has had recently

Your healthcare provider will examine your child. Your child may have blood tests. In some cases, your child may have a bone marrow biopsy, which uses a needle passed through the skin into the bone marrow to take a small sample of tissue for testing.

How is it treated?

Mild cases of ITP may not need treatment. If needed, the goal of treatment is to increase platelet counts to prevent bleeding. Treatment may include:

• Medicines that help control your child’s immune system such as steroids or chemotherapy drugs
• Platelet transfusions to increase platelet counts
• Rarely, surgery to remove the spleen
• Rarely, antiviral medicine

Your child may need treatment in a hospital for any serious bleeding.

Most children get better within six months. A few children need more long-term treatment.

How can I take care of my child?

• Help your child stay physically active as advised by your child’s provider. Follow your provider's advice for how much rest your child needs.
• Your child should avoid contact sports such as football or soccer and other activities that are more likely to cause injuries.
• Your child should avoid injury by wearing a seat belt in a car or a helmet when on a bicycle or motorcycle, and by wearing protective gloves when using knives or working outside.
• Tell your healthcare provider about all the medicines your child takes. Some medicines can increase the risk for bleeding. Don’t give your child aspirin, ibuprofen, or naproxen. Children and teens who take aspirin are at risk for a serious illness called Reye’s syndrome.
• Have your child brush and floss teeth daily. Let your child’s dentist know that your child has ITP. Notify your child’s healthcare provider before any dental procedure.
• Help your child eat a healthy diet. Ask your child’s healthcare provider if your child needs any dietary changes.
• Your child should avoid drinking alcohol.
• For older girls, tell your child’s healthcare provider if your child is having a very heavy menstrual flow. Also, tell your child’s healthcare provider if your child is pregnant. Medicines to treat ITP may not be safe for pregnant women. Your child may need more healthcare provider visits during her pregnancy to help keep her and her baby healthy.

Follow your child’s healthcare provider's instructions. Ask your provider:

• How long it will take for your child to recover
• If there are activities your child should avoid and when your child can return to normal activities
• How to take care of your child at home
• What symptoms or problems you should watch for and what to do if your child has them

Make sure you know when your child should come back for a checkup. Keep all appointments for provider visits or tests.