Immune Thrombocytopenia

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What is immune thrombocytopenia (ITP)?

Children with immune thrombocytopenia (ITP) may bruise or bleed easily because the disease destroys platelets. Platelets are the blood cells that help form clots to stop bleeding and close wounds.

The condition is pronounced im-YOON throm-boh-site-oh-PEE-nee-ah.

For most children, ITP goes away within 6 months, often within a few weeks. When ITP lasts longer than 12 months, it is called chronic ITP. Chronic ITP happens in about 1 in 5 children with the disease.

ITP is also called immune thrombocytopenic purpura or idiopathic (ih-dee-uh-PAAH-thik) thrombocytopenic purpura.

What causes ITP?
Normally, the immune system helps prevent and fight infection. But in ITP, the immune system attacks and destroys the body's platelets. We are not sure why. When the immune system attacks cells in a patient’s own body, it is called an autoimmune disease. It sometimes happens when children:
- Get some kinds of viruses
- Take some kinds of medicines
- Have certain kinds of immune disorders
Even though ITP can start with a virus, it is not an infection. Your child can not catch ITP from someone else.

Cancer and Blood Disorder Care at Seattle Children's

Our team treats children, teens and young adults, including those with the hardest-to-treat cancers and blood disorders. We provide treatment options that many centers do not offer.

Symptoms of ITP

Most symptoms of ITP are from bleeding problems because your child has fewer platelets than normal. Symptoms may include:

Bleeding more easily than usual.
Bruising or purplish areas on the skin (purpura). These are caused by bleeding under the skin.
Tiny round red spots on the skin that may look like a rash. This is called petechiae (puh-TEE-key-eye) and is caused by bleeding under the skin.
Nosebleeds
Bleeding from the gums or having blood blisters in the mouth.
Blood in your child's pee (urine) or bowel movements (stool).
Any bleeding that is difficult to stop.
Heavy menstrual bleeding.

Diagnosing ITP

Different health problems can cause low platelet levels. Your child's healthcare team will talk to you in detail about your child's health. They will ask about your child's:

Symptoms
Recent illnesses
Medicines that may affect platelets
Any immune system problems that your child might have

To find out if your child has ITP, their healthcare provider will:

Look for signs of bruising or bleeding under the skin.
Check for other health problems.
Do blood tests.
Sometimes, get a sample of bone marrow. The test is called bone marrow aspiration or biopsy.

Treating ITP

Children with ITP can lead active, normal lives. Many children do not need treatment. ITP often goes away on its own in a few weeks or months.

We watch your child closely and recommend the best treatments for them. Treatment does not cure ITP, but it will often increase the number of platelets. Most treatments slow down the loss of platelets. A few treatments help your child make more platelets.

Often, children who need medicine or blood products into their vein (infusion) can get care without having to spend a night in the hospital. Our outpatient infusion unit is staffed by expert nurses and is open every day.

Many people wonder about blood transfusions as a treatment. We almost never use platelet transfusions to treat ITP because the spleen quickly destroys the new platelets.

At Seattle Children’s we care for children with ITP in these ways:

Watchful waiting
If your child does not have serious bleeding symptoms, we usually recommend watchful waiting. This means we regularly check your child for symptoms of active bleeding and provide treatment if needed. These symptoms include:
- Nosebleeds longer than 5 minutes
- Blood in pee or bowel movements
- Bleeding from the gums
- Severe headache
Preventing bleeding
We help you and your child lower the risk of bleeding problems.

Your child’s provider may recommend that your child:
- Avoid certain contact sports, such as tackle football, boxing and hockey. If your child wants to play noncontact sports, your doctor may suggest treatments to increase their platelet levels.
- Avoid medicines that increase bleeding, such as aspirin and ibuprofen (Advil). Your child's doctor can give you details about which medicines to avoid.
Call your child’s provider if your child has these signs of bleeding problems:
- Bowel movements that look dark or like tar
- Dark or red pee
- A bad headache or head injury
- More bruising than usual
- Any bleeding other than very minor bleeding, such as bleeding in the mouth or more than a few drops of blood from the nose
To call your child's provider:
- Weekdays between 8 a.m. and 5 p.m., call the clinic at 206-987-2106. Ask for the triage nurse.
- Weekdays before 8 a.m. and after 5 p.m. and on weekends and holidays, call 206-987-2000. Ask for the “on-call hematology fellow.”
Corticosteroids

Steroids (such as prednisone or dexamethasone) decrease antibody production and may help slow down how fast the spleen removes platelets from the blood. Most children take these medicines by mouth.

If your child gets this treatment, their team will talk with you about how to manage side effects, such as changes in appetite or mood.
Intravenous immunoglobulin (IVIG)

Immunoglobulin (ih-myoo-noe-GLAH-byoo-lin) contains many proteins that fight infection (antibodies). It may help block the antibodies that destroy platelets.

It is given into your child’s vein over several hours. This is called an intravenous (IV) infusion. IV immunoglobulin (IVIG) is also called IV gamma globulin. It is made from the liquid part of blood (blood plasma) from healthy donors.

Most children who need IVIG stay overnight in the hospital. We watch your child for side effects that happen in some children. These include nausea or headache.
Other medicines
If your child’s ITP is very serious or long-lasting, your child’s doctor will talk with you about other medicines. Some are taken by mouth and some are given by an injection.

The doctor may recommend medicines that:
- Calm down the immune system
- Boost platelet production (eltrombopag and romiplostim)
Surgery to remove the spleen

If your child’s ITP is severe and medicine is not working, the doctor may recommend removing your child’s spleen. This is called splenectomy.

Normally, the spleen makes proteins called antibodies that help fight infection. In children with ITP, these antibodies destroy platelets instead.

Without a spleen, your child has an increased risk of infection. Your child’s doctor will explain how to help avoid infections, such as getting extra immunizations. The team will tell you what symptoms to watch for.
Checking platelets

We usually check your child's platelet count at each clinic visit. A normal platelet count is above 100,000. Your child’s provider will talk with you about other times your child's platelet count should be checked, such as after any treatment for bleeding or if new symptoms start.

We will work with you and with your child’s primary care provider to decide where to have blood tests done and who can help explain the results.

ITP at Seattle Children’s

ITP often goes away on its own in weeks or months. Our experience helps us know when your child does need treatment and which treatment is best for them.

Experts at our Cancer and Blood Disorders Center focus on helping you understand what is happening with your child's platelets and how to know if a more serious problem is developing.

If you would like an appointment, ask your primary care provider to refer you. If you have a referral or would like a second opinion, contact the center at 206-987-2106.

Providers, see how to refer a patient.

The experts you need

Our doctors are nationally known for treating children who have blood disorders. The doctors who will guide your child’s care are board certified in pediatric oncology-hematology. This means they are approved to give the special care your child needs and they constantly expand their knowledge about blood disorders.

Our surgeons are board certified in pediatric surgery. They are skilled at doing laparoscopic surgery, using smaller cuts than traditional procedures.

In rare cases, ITP is a clue that a child’s immune system may not be normal. If we have concerns about your child, we work closely with specialists at our Immunology Clinic. The clinic has over 40 years of experience diagnosing and treating children.

Rarely, children with ITP may have, or may develop, a more general autoimmune disease such as lupus. Seattle Children’s rheumatology experts help diagnose and treat children with such conditions.
Complete care tailored to your child

We keep a careful watch on your child’s health. We recommend the right treatment at the right time to have the best results for your child and your family.

If your child needs treatment, we offer a full range of medicines. We stay informed of new treatments being developed and take part in clinical trials of new options.

We care for your whole child. Your family has a full team behind you, including doctors, nurses, social workers and other specialists as needed. Read more about the supportive care we offer.
Among the nation’s top children’s hospitals

Our specialty is treating children’s conditions while helping them grow up to be healthy and productive. Our physician-scientists help set national standards for care of young people with blood disorders.

Children do not react to illness, injury, pain and medicine in the same way as adults. They need – and deserve – care designed just for them. Our experts focus on how treatments today affect growing bodies in the future. We plan your child’s treatment based on years of experience and the newest research on what works best – and most safely – for children.
Support for your whole family

Although ITP is mild in some children, other kids have serious bleeding problems. We will see your child in our clinic or emergency department that same day if they have signs of active bleeding, such as a nosebleed lasting longer than 5 minutes. Some children need to stay overnight in the hospital for treatment. If needs are not urgent, most new patients are seen within 1 or 2 weeks.

During visits, we take time to explain your child’s condition. We help you fully understand your treatment options and make the choices that are right for your family.

Our child life specialists and social workers help your child and your family through the challenges of this condition. We connect you to community resources and support groups.

At Seattle Children's, we work with many children and families from around the Northwest and beyond. Whether you live nearby or far away, we can help with financial counseling, schooling, housing, transportation, interpreter services and spiritual care. Read about our services for patients and families.