Immune Thrombocytopenia (ITP)


Immune thrombocytopenia (ITP) is a rare blood disorder in which the immune system attacks and destroys normal platelets in the blood. Platelets are cell fragments that are required for blood clotting.1

Bleeding Risk

Immune thrombocytopenia causes abnormally low platelet levels and this can increase the risk for bleeding and bruising. Purple-colored bruising, called purpura, may be visible on the skin and mucous membranes, such as those that line the mouth. Purpura can be one of the first noticeable signs of ITP.2 

Not all people with low platelet levels experience bleeding, but the risk is generally higher in individuals with ITP. For this reason, people with a diagnosis of ITP must take certain precautions to prevent bleeding.2

Read more about ITP complications

Medications

Some over-the-counter and prescription medications exacerbate the already increased risk for bleeding in people with ITP. These include aspirin, ibuprofen (such as Advil® and Motrin®), other nonsteroidal anti-inflammatory drugs (NSAIDs), and blood thinners (anticoagulants), such as warfarin and heparin.1 

It is important that patients with ITP check with their doctor before taking any new medications, herbal remedies, or supplements, to make sure that these will not further increase the risk for bleeding. It is also important that all medications be taken as directed.1

Medical Care and Monitoring 

Patients with ITP should have their platelet, red cell, and white blood cell levels checked routinely by their primary care doctor. If a provider has prescribed corticosteroids to treat symptoms of ITP, the patient’s blood pressure, blood sugar level, and bone density must be routinely monitored. Patients should also be watched for mood and sleep disturbances, visual changes (glaucoma), muscle problems, and stomach problems, including ulcers.3 Patients should share their ITP condition status with their dentist because they are at high risk for gum bleeding.

Although it occurs rarely, severe bleeding is possible, and patients may require emergency care, including blood transfusions to increase the platelet count or emergency surgery to decrease cerebral pressure if bleeding occurs in the brain.4

A physician should be contacted if any of the following symptoms develop1:

  • Stiff neck
  • Severe headache, confusion, or visual changes 
  • Head injury or other significant injury that causes bleeding
  • Unusually heavy menstrual bleeding in women with ITP
  • Bleeding in the nose or gums that does not stop 
  • Blood in the urine or stool
  • Easy bruising or bleeding for no apparent reason

Read more about ITP signs and symptoms

Contact Sports

To reduce the risk for head injury and bleeding, contact sports such as boxing, football, martial arts, and possibly soccer (heading the ball) should be avoided. Any blow to the head may cause bleeding in the brain, which can be life-threatening in a person with ITP. People with ITP should check with their doctor before engaging in any athletic activities to assess their risk for injury.4

Read more about ITP risk factors

Diet

Alcohol intake should be limited because alcohol decreases the ability of the blood to clot and increases the risk for bleeding.1

Read more about ITP diet and nutrition

Lifestyle Modifications

To avoid bleeding, people with ITP should try to avoid bumping or bruising themselves. Shaving with an electric razor, cleaning the teeth with a soft-bristle or sponge (without bristles) toothbrush, and taking extra care in the handling of sharp objects such as knives, scissors, and nail trimmers may reduce the chance for cuts and decrease bleeding risk. Blowing the nose gently decreases the potential for nosebleeds.1 It is recommended that patients wear shoes with thick, hard soles when walking outside, and wear gloves and long pants while gardening or participating in any activities that increase the risk for being cut or scratched.1

Post Splenectomy

The spleen is the organ where platelets are destroyed in ITP. After one year, if multiple treatments fail to relieve the symptoms of ITP, splenectomy may be the best option to restore normal platelet levels and reduce or even cure the symptoms of ITP.3

The spleen plays an important role in enabling the immune system to fight off infection, so people with ITP who have undergone splenectomy are especially susceptible to infection. It is important that these ITP patients watch for signs of infection, such as fever and fatigue. If an infection is suspected, they should seek prompt treatment.4

Read more about ITP surgical management

Pregnancy

Pregnant women with ITP require care from an obstetrician who is knowledgeable about ITP because the disease increases their risk for bleeding and complications. They require frequent monitoring and coordination of care with other disciplines to ensure a safe delivery.5

References

  1. Discharge instructions for immune thrombocytopenia purpura (ITP). Saint Luke’s. Accessed October 15, 2022.
  2. Purpura. Mount Sinai. Accessed October 15, 2022.
  3. Neunert C, Terrell DR, Arnold DM, et al. American Society of Hematology 2019 guidelines for immune thrombocytopenia. Blood Adv. 2019;3(23):3829-3866. doi:10.1182/bloodadvances.2019000966
  4. Immune thrombocytopenic (ITP). Mayo Clinic. Accessed October 15, 2022.
  5. Poston JN, Gernsheimer TB. Management of immune thrombocytopenia in pregnancy. Ann Blood. 2021;6(0). doi:10.21037/aob-20-58

Reviewed by Harshi Dhingra, MD, on 10/17/2022.

READ MORE ON ITP