Immune thrombocytopenia (ITP): Your experts in childhood blood disorders

ITP in children happens most often between the ages of 2 and 5. It doesn’t have a clear cause but is more likely to occur after a viral illness. Sometimes, it happens after taking certain medications or with immune disorders such as lupus.

For most children, ITP is a short-term condition and usually goes away within six months — sometimes even within a few weeks. About 15% of children who develop ITP will continue having symptoms for longer than six months. This is considered long-term, or chronic ITP.

Symptoms

Some of the common symptoms of ITP include:

• Tiny, red or purple spots, also known as petechiae, on the skin or lining of your mouth

• Painless, dime-sized bruises on the skin or in the mouth, also known as purpura

• Easy bruising

• Nose bleeds

• Bleeding gums

• Heavy menstrual bleeding

• Blood in your child’s urine or stool

• Changes in mental status (this is rare)

Diagnosis

Your child’s health care team will perform a complete medical history and physical exam. They will also do blood tests to see how well the blood is clotting and to check the platelet count. They may also test your child’s blood for antibodies against your platelets. In rare cases, it is necessary to get a sample of the bone marrow through a biopsy.

Treatment comes into play when a child has active bleeding symptoms or very a low platelet count. If treatment is recommended, some of the common options include:

• Steroids such as prednisone or dexamethasone given by mouth. These help raise the platelet count in the blood by slowing the immune system;

• Immunoglobulin (IVIg), which is given intravenously (IV), helps slow the immune system from destroying platelets;

• Anti-(Rh) D immunoglobulin (WinRho®), which is given intravenously (IV), helps slow the immune system from destroying platelets;

• Rituximab (Rituxan®), which is given intravenously (IV), helps the immune system target and destroy a certain type of cell that destroys your platelets;

• Romiplostim (Nplate®), which is given under the skin, helps the bone marrow make more platelets;

• Eltrombopag (Promacta®), a tablet given by mouth, helps your bone marrow make more platelets;

• Cyclosporine (CSA), a tablet given by mouth, helps slow the immune system from destroying platelets.

You may also need other drugs that slow the immune system.

Surgery

In rare cases — especially if your child’s ITP is severe and medications are not effective — your doctor may recommend removing your child’s spleen (splenectomy). Since the platelets get trapped in the spleen, taking out the spleen helps to stop the breakdown. If your child’s spleen is removed, they may be more likely to get infections.

Platelet transfusions

Transfusion of platelets may be an option if your child is having severe or life-threatening bleeding.

Activity and medication restrictions

Your care team will recommend that while your child’s platelet count is low, it's best to avoid sports that are potentially dangerous, such as tackle football, wrestling, hockey, and rugby.

Your child may need to avoid NSAIDs, such as aspirin, ibuprofen and naproxen. These medicines make your platelets less able to clot and cause bleeding. Make sure your child’s provider knows all the medicines your child is taking, including supplements and over-the-counter medicines.