A rough idea of how many platelets are circulating in the bloodstream platelet count can be made using a sample of blood. However in the UK we simplify this by describing a platelet count of, say, rather than , In most cases of ITP the platelet count is less than What is immune thrombocytopenic purpura?
The majority of children with "chronic" ITP will still have some recovery of the platelet count at a later date and the majority of younger children will still completely recover after a few years even if the ITP is still present at 6 months.
How common is ITP and who does it affect? About four in every , children develop ITP each year. There seem to be two groups who develop ITP: young children and young adults.
It is more common in girls than boys. What are the symptoms of ITP? Most children with a platelet count of under 20 will have petechiae pinprick blood spots under the skin and limited bruising.
Bruising most commonly follows minor knocks "easy bruising" but may also occur spontaneously without trauma. Common sites of spontaneous bleeding are the gums and nose. Girls may be troubled with heavy periods. Less common and potentially serious are spontaneous bleeds occurring from the gut or brain. Data from international studies suggests that the risk of serious bleeds is about 3 in children and the risk of brain bleeds is about 1 in children. These bleeds most often occurred in the first week of ITP and were often caused by a rare pre-existing abnormality of the blood vessels in the head.
The risk of serious bleeding is much lower when the platelet count recovers to over What causes ITP? ITP commonly results due to the immune system mistaking platelets as being foreign and attacking the platelets. In many cases this may follow a viral infection or vaccination during which time the immune system attacks the virus but the immune system then goes on to think that the platelets are viral material and starts to attack the platelets.
How is ITP diagnosed? This is to rule out other conditions that may cause similar symptoms to ITP. If the platelets, red blood cells and white blood cells all look normal, this rules out leukaemia. If the low platelet count improves quickly and no treatment is needed, your child will not need any further tests.
If the platelet count is not showing signs of recovery by 3 to 6 months then a small sample of bone marrow will need to be taken and examined under the microscope. Additional blood tests may be taken at this time to exclude rare clotting or immune diseases that can mimic ITP.
If the bone marrow looks normal, with the usual or higher number of platelet parent cells megakaryocytes and other blood tests are normal then the doctor will diagnose chronic ITP. What is the outlook for children with ITP? Always consult your health care provider for a diagnosis. Historically, a bone marrow aspiration was required to make a diagnosis of ITP. It may not be absolutely necessary in the face of a positive antiplatelet antibody test, but it is still commonly done to look at the production of platelets and to rule out any abnormal cells the marrow may be producing that could lower platelet counts.
A bone marrow aspiration is necessary for a diagnosis if the antiplatelet antibody testing is negative. Specific treatment for idiopathic thrombocytopenic purpura will be determined by your health care provider based on:.
When treatment is necessary, the two most common forms of immediate treatment are steroids and intravenous gamma globulin:. Health Home Conditions and Diseases. Thrombocytopenia means a decreased number of platelets in the blood. Purpura refers to the purple discoloring of the skin, as with a bruise.
ITP is a fairly common blood disorder that both children and adults can develop. There are two forms of ITP: Acute thrombocytopenic purpura. This usually affects young children, ages 2 to 6 years old. The symptoms may follow a viral illness, such as chickenpox. Acute ITP usually starts suddenly and the symptoms usually disappear in less than 6 months, often within a few weeks. Treatment is often not needed. The disorder usually does not recur.
Acute ITP is the most common form of the disorder. Chronic thrombocytopenic purpura. The onset of the disorder can happen at any age, and the symptoms can last a minimum of 6 months, several years, or a lifetime. Adults have this form more often than children do, but it does affect adolescents.
Females have it more often than males. Chronic ITP can recur often and requires continual follow-up care with a blood specialist hematologist. What causes idiopathic thrombocytopenic purpura?
This immune system error may be a result of any of the following: Medications including over-the-counter medications can cause an allergy that cross-reacts with platelets.
Infections, typically viral infections, including the viruses that cause chicken pox, hepatitis C, and AIDS, can prompt antibodies that cross-react with platelets. Pregnancy Immune disorders, such as rheumatoid arthritis and lupus Low-grade lymphomas and leukemias may produce abnormal antibodies against platelet proteins.
Sometimes the cause of immune thrombocytopenic purpura is not known. What are the symptoms of idiopathic thrombocytopenic purpura? Symptoms may include: The purple color of the skin after blood has "leaked" under it. A bruise is blood under the skin. Persons with ITP may have large bruises from no known injury. Bruises can appear at the joints of elbows and knees just from movement. Low-grade lymphomas and leukemias, which may make abnormal antibodies that attack platelets.
A normal platelet count is about , to , With ITP, the platelet count is less than , By the time major bleeding occurs, you may have a platelet count of less than 10, The lower your platelet count, the greater your risk of bleeding. Because platelets help stop bleeding, ITP symptoms are linked to increased bleeding. Symptoms may include:. Bruising or purple areas on the skin. These bruises called purpura are caused by bleeding under the skin.
When you have ITP, bruises may occur for no known reason. They can appear at elbow and knee joints just from movement. Bleeding in your head. This symptom of ITP is the most dangerous. ITP symptoms may look like other health problems. Always see your healthcare provider for a diagnosis.
Your healthcare provider will take your health history and give you a physical exam. Your provider may ask about any medicines you are taking that may cause bleeding or lower your platelet count. You may also have these tests:. Complete blood count CBC. This test checks the number of red blood cells, white blood cells, and platelets in your blood.
With ITP, the red and white blood cell counts will be normal, but the platelet count will be low. Peripheral blood smear. This test is used as a follow-up test to an abnormal CBC. It checks different types of blood cells, in particular platelets for ITP. Other blood and urine tests. These tests are done to measure bleeding time and find possible infections.
Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is. When treatment is needed, the 2 most common forms of immediate treatment are steroids and intravenous immunoglobulin IVIG :. These medicines help prevent bleeding by slowing down platelet destruction. They can lead to a higher platelet count in 2 to 3 weeks. Side effects may include feeling grouchy, stomach irritation, weight gain, high blood pressure, and acne. Intravenous immunoglobulin IVIG.
IVIG is made of antibodies removed from blood donations from thousands of healthy donors. IVIG helps by increasing your platelet count. You may see a response in as little as 24 to 48 hours. Rh immune globulin. This medicine briefly stops the spleen from destroying platelets. You must be Rh positive and have a spleen for this medicine to work.
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