Immune thrombocytopenia (ITP), sometimes called immune thrombocytopenic purpura or idiopathic thrombocytopenic purpura, is an autoimmune disorder that occurs when your child’s body attacks its own platelets and destroys them too quickly. Platelets are a part of blood that helps control bleeding. ITP affects at least 30,000 children under the age of 16 each year in India.
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.
ITP Treatment
Children and young adults with immune thrombocytopenia are treated through the Blood Disorders Center. To learn more about ITP, continue reading below.
What is immune thrombocytopenia (ITP)?
Immune thrombocytopenia (ITP) is an autoimmune disorder (meaning the immune system attacks the body’s own tissues) that occurs when the body attacks its platelets, a part of the blood that helps control bleeding by forming blood clots.
- In healthy children, the body produces proteins called antibodies that guard against infection.
- ITP causes a child’s body to make abnormal antibodies that stick to platelets, which the spleen (the organ that helps filter infections in the blood) recognizes as signs of infection and destroys.
- In a child with ITP, the body is producing platelets normally but also destroying them too quickly, with platelets surviving only a few hours instead of the normal seven to 10 days.
- The end result is a low platelet count in the blood.
ITP Symptoms in Children
There are two types of 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 arise suddenly and usually disappear in less than six months, often within a few weeks.
- Acute ITP usually does not recur after the child gets better.
Chronic thrombocytopenia is more common in adults but can occur in children.
- Symptoms of chronic ITP last a minimum of six months and can persist for many years.
- Chronic ITP can require regular follow-up care with a hematologist (a doctor who specializes in blood disorders).
How do you diagnose ITP in children?
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.
How do you treat ITP in children?
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 may include:
- 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 latest ITP research?
Dana-Farber/Boston Children’s Cancer and Blood Disorders Center is a world leader in ITP research. We are currently conducting a number of studies to improve the diagnosis and treatment of ITP and other platelet disorders.
- ITP Consortium of North America (ICON): Boston Children’s leads a North American Consortium of pediatric ITP physicians and researchers. We are conducting a multi-center research study to understand how second-line ITP treatments are selected and which second-line treatments work best to improve bleeding, quality of life, and platelet counts in pediatric refractory ITP.
- International splenectomy registry: Researchers are collecting information internationally regarding splenectomy (surgical removal of the spleen) in young persons with ITP. This study may lead to the better understanding of the effects of splenectomy on children and young adults with ITP.
- Intercontinental childhood ITP registry: We participate in a large, international study to help better define the long-term course in children newly diagnosed with ITP. Once this information is carefully analyzed, it may lead to the development of new treatment guidelines that will improve the care of children with ITP.
- ITP Bleeding Study: We are participating in a research study to understand why certain children with low platelet counts have more bleeding symptoms than other children with similarly low platelet counts.
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.
Can my child participate in sports or other athletic activities?
The sports and activities that your child can participate in will depend on her platelet count (the severity of the ITP). Your child’s physician can make specific recommendations on the types of activities that may be appropriate for her depending on her platelet levels. (Learn more about ITP and sports on our ITP Kids pages.)
Frequently Asked Questions
What is immune thrombocytopenia?
Immune thrombocytopenia, also known as ITP, is a disorder characterized by a low level of platelets in the blood. This can lead to an increased risk of bleeding and bruising.
What are the common symptoms of ITP?
Common symptoms of ITP include easy bruising, petechiae (small red or purple dots on the skin), prolonged bleeding from cuts, and heavy menstrual bleeding.
How is ITP diagnosed?
ITP is diagnosed through a physical examination, blood tests to check platelet levels, and possibly a bone marrow biopsy to rule out other potential causes.
What are the treatment options for ITP?
Treatment options for ITP depend on the severity of the condition. They may include medication, such as corticosteroids or immunosuppressants, platelet transfusions, or in some cases, surgical removal of the spleen.
How much does the treatment for ITP cost?
The cost of treatment for ITP can vary depending on various factors, including the type of treatment prescribed, duration of treatment, and healthcare provider. It is recommended to consult with a hematologist or healthcare professional for specific cost information.
Can I use alternative therapies alongside ITP treatment?
The use of alternative therapies or complementary treatments alongside ITP treatment should be discussed with your hematologist or healthcare provider. Some treatments may interact with each other and it is important to ensure their safety and effectiveness when combined.
Are there any dietary restrictions for people with ITP?
Avoid processed foods and limit your sugar.There are no specific dietary restrictions for people with ITP. However, maintaining a healthy and balanced diet is generally recommended to support overall health and well-being.
What are the benefits of early diagnosis and treatment of ITP?
Early diagnosis and treatment of ITP can help manage symptoms, improve platelet levels, and reduce the risk of bleeding or other complications associated with low platelet counts. It can also improve overall quality of life.
How long does it take for ITP treatment to show results?
The time it takes for ITP treatment to show results may vary depending on the individual and the chosen treatment approach. It is important to follow the prescribed treatment plan and discuss any concerns or lack of improvement with your healthcare provider.
What should I do if I experience unexpected bleeding or bruising during ITP treatment?
If you experience unexpected bleeding or bruising while undergoing ITP treatment, it is important to contact your healthcare provider immediately. They can assess the situation, adjust the treatment plan if necessary, or provide further guidance.
What should I do if I miss a dose of my ITP medication?
If you miss a dose of your ITP medication, it is recommended to follow the instructions provided by your healthcare provider or the medication's packaging. If you have any concerns or doubts, contact your healthcare provider for guidance.
How can I manage side effects of ITP treatment?
Managing side effects of ITP treatment should be discussed with your healthcare provider. They can provide guidance on minimizing or managing side effects, and may make adjustments to your treatment plan if needed. It is important to communicate openly with your healthcare provider about any side effects you experience.
