Immune Thrombocytopenia (ITP): Symptoms, Causes, and Treatment

Regarding conditions like Immune Thrombocytopenia (ITP), it's not just about understanding what it is but also about recognizing its signs, knowing its causes, and exploring available treatments.

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What Is ITP?

Immune Thrombocytopenia, commonly referred to as ITP is a blood disorder characterized by a decreased number of platelets in the blood. Platelets in the bone marrow play a crucial role in blood clotting and stopping bleeding. Symptoms such as bruising, bleeding gums, and purpura (purple or red spots on the skin) may occur when their count is low.

ITP was formerly known as idiopathic thrombocytopenic purpura. The term "idiopathic" implies that the cause is unknown, but we now understand that ITP is an autoimmune disorder. Meaning the body's immune system mistakenly attacks its platelets, destroying them and resulting in thrombocytopenia - an abnormally low platelet count.

There are two primary forms of ITP: acute and chronic. Acute ITP often lasts less than 6 months and is more common in children. In comparison, chronic ITP lasts 6 months or longer and is typically seen in adults, affecting women more than men. Despite being a challenging condition, understanding ITP is the first step towards managing it effectively.

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What are the symptoms of ITP?

Immune Thrombocytopenia (ITP) is a condition marked by a decrease in platelets, the blood components that aid in stopping bleeding. A normal platelet count ranges from 150,000 to 450,000, but with ITP, this number can drop below 100,000. Significant bleeding can occur at counts below 10,000. The lower the platelet count, the greater the risk of bleeding.

Some individuals with ITP might not show any noticeable symptoms. However, when symptoms manifest, they are related to increased bleeding due to the decreased platelet count. Here's what you might observe:

Purple discoloration of skin occurs when blood "leaks" under the skin, often resembling large bruises without a known injury.
Bruises at joints: These can appear from mere movement due to the fragility of blood vessels.
Tiny red dots (petechiae)appear under the skin due to very minor bleeding.
Reddish-purple spots Also known as purpura, mainly appear on the lower legs and resemble a rash.
Nosebleeds and gum bleeding are common symptoms of ITP.
Heavy menstrual periods: Some women may experience an unusually heavy menstrual flow.
Presence of blood in vomit, urine, or stools is a sign of internal bleeding.
Hematoma: Blood can clot or partially clot under the skin, forming lumps.
Bleeding in the head is one of the most dangerous symptoms, especially after a head injury when the platelet count is insufficient.
Extreme tiredness is also a manifestation of ITP.

These symptoms may resemble other medical conditions. Therefore, it is always advised to consult with a healthcare provider for an accurate diagnosis.

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What causes ITP?

Immune Thrombocytopenia (ITP) is a condition where the immune system, which is typically responsible for fighting infections, mistakenly attacks the body's platelets. This often happens when the immune system produces antibodies against these platelets. While the exact cause of ITP can sometimes be unknown, several factors have been associated with the development of this condition. Here are some key causes and risk factors:

Infections: Certain infections, especially viral ones, can stimulate the production of antibodies that target platelets. Infections like HIV, hepatitis, and H. pylori have been associated with ITP. In children, ITP can follow viral infections.
Medications: Some medications can cause reactions that target platelets, increasing the risk of ITP.
Vaccines: Certain vaccines, particularly the measles-mumps-rubella (MMR) vaccine, can increase the risk of ITP. Recent studies have also pointed to a potential link between the administration of certain COVID-19 vaccines and the onset of Immune Thrombocytopenia (ITP).
Autoimmune diseases: There is a link between ITP and other autoimmune diseases, such as rheumatoid arthritis and lupus.
Primary and Secondary ITP: Primary ITP is not linked to other diseases, while Secondary ITP is associated with other conditions, such as autoimmune diseases or chronic viral infections.

It's important to note that ITP seems more common among young women, and certain risk factors, including certain medicines, infections, and vaccines, can increase the likelihood of developing this condition.

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Immune Thrombocytopenia (ITP): Symptoms, Causes, and Treatment

How Is ITP Diagnosed?

Diagnosing Immune Thrombocytopenia (ITP) typically involves a series of blood tests, a full medical history, and a physical exam. Because ITP is often a diagnosis of exclusion, healthcare providers aim to exclude other causes of a low platelet count before confirming a diagnosis of ITP. Here are the steps usually taken in diagnosing ITP:

Complete Blood Count (CBC): CBC measures the size, number, and maturity of different blood cells in a specific blood volume. This count is primarily used to measure platelets.
Medical History and Physical Exam: Most of the time, ITP has no symptoms. As such, your healthcare provider will take a comprehensive medical history and perform a physical exam to help identify any signs or symptoms of ITP.
Additional Blood and Urine Tests: These assess bleeding time and infections and include the antiplatelet antibody test, which detect antibodies against platelets in the bloodstream.

For children, the diagnosis process is slightly different:

Diagnosis of Exclusion and Blood Test: A diagnosis of exclusion is made when all other potential problems have been ruled out. A blood test is then conducted to confirm the diagnosis.

For adults, the process may sometimes include an additional step:

Bone Marrow Aspiration or Biopsy: This is rarely needed but might be performed 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 becomes necessary for a diagnosis if the antiplatelet antibody testing is negative.

By following these steps, healthcare providers can accurately diagnose ITP and commence appropriate treatment.

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What Is the Prognosis for ITP?

The prognosis for Immune Thrombocytopenia (ITP) varies based on several factors, including disease type, response to treatment, age at disease onset, sex, and severity of low platelet counts leading to serious bleeding complications. Despite these variables, most patients with ITP have a life expectancy similar to the general population.

Acute ITP predominantly affects children and often resolves spontaneously within six months or less without treatment. Over 80% of untreated children with acute ITP achieve clinical remission spontaneously.

On the other hand, Chronic ITP can last for many years. It is more common in adults; only about 2% of adults spontaneously recover. However, patients can survive for decades with the disease. Approximately 64% of adults with ITP recover with treatment, 30% develop chronic ITP, and about 5% die from a hemorrhage.

The overall prognosis for children and adults with ITP is generally good, with most patients achieving complete recovery. The prognosis for acute ITP is particularly favorable, while chronic ITP typically requires treatment and may involve relapses.

How is ITP Treated?

The treatment for Immune Thrombocytopenia (ITP) is determined by several factors, including the patient's age, overall health, the extent of the disease, tolerance for specific medications, and personal preference.

Some patients with mild ITP and no bleeding symptoms may not require specific treatment. However, for those who do, there are several options:

Steroids are often the first-line treatments for ITP. They help increase platelet counts by decreasing the activity of the immune system.
Intravenous Gamma Globulin (IVGG) has to be given by an intravenous infusion and may take a couple of hours. IVGG works by blocking the antibodies that destroy platelets.
Rh Immune Globulin can be used in patients with certain blood types to boost the body's production of platelets.
Medication Changes: If a medication is suspected of causing ITP, your doctor may suggest changing or stopping that medication.
Infection Treatment: If your ITP is linked to an infection, treating that infection can help improve your platelet count.
Splenectomy: This surgical procedure removes the spleen, often the site of platelet destruction in ITP. Splenectomy can cure ITP in about 70% of chronic cases.
Platelet Transfusionmight be necessary in severe cases, especially if there's significant bleeding or a risk of it.
Rituximab and other Monoclonal Antibodies to CD20 are drugs that target and destroy B cells that produce antiplatelet antibodies.
Romiplostim and Eltrombopag (Thrombopoietin analogues): These medications stimulate the bone marrow to produce more platelets.
Lifestyle Changes can include avoiding activities that could cause injury and bleeding, eating a healthy diet, and taking care of your teeth and gums to prevent bleeding.

The severity and duration of ITP influence the choice of treatment. It's also important to note that relapses can occur, requiring repeat treatment, and viral infections may trigger them. With the right approach, most patients with ITP can lead normal, healthy lives.

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What Are Some Support and Resources for People with ITP?

Living with a rare diagnosis like Immune Thrombocytopenia (ITP) can be challenging, but remember, you're not alone. There are various resources and support systems available to help you navigate this journey.

Support Groups
Discussion Groups

Online discussion groups offer another great way to engage with the ITP community. These platforms provide opportunities to ask questions, share your journey, and learn from the experiences of others living with ITP. Join the conversation at PDSA Discussion Groups.

Reaching out for support is a sign of strength. Connecting with others who understand your experience provides emotional support, practical tips, and a sense of community.
What are the phases of ITP?
ITP is categorized into three phases:
- Newly diagnosed ITP occurs within 3 months from diagnosis.
- Persistent ITP lasts from 3 to 12 months from diagnosis.
- Chronic ITP lasts for more than 12 months.
How does ITP affect daily life?
What foods should I avoid with ITP?

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What Are Some Complications of ITP?

While Immune Thrombocytopenia (ITP) is generally manageable, certain complications can arise, mainly due to the low platelet count associated with the condition. Here are some potential complications:

Bleeding Complications are a significant concern, especially when platelet counts drop below a certain threshold. The most dangerous complication of ITP is severe bleeding, which can occur even from minor injuries.
Brain Bleeding: Although rare, intracranial hemorrhage (ICH) is a potentially fatal complication associated with ITP.
Long-Term Corticosteroid Use: Corticosteroids are commonly used to manage ITP but may have long-term side effects. These include osteoporosis, cataracts, muscle loss, increased infection susceptibility, and diabetes.
Splenectomy Risks: While removing the spleen can cure ITP in some cases, it does increase the risk of bacterial infections significantly.
Pregnancy Complications: Pregnant individuals with ITP require special attention to manage platelet counts and prevent heavy bleeding during delivery. While ITP generally does not affect the fetus, the baby's platelet count should be monitored after birth.

As with any medical condition, it's crucial to consult with healthcare providers regularly to manage ITP effectively and minimize potential complications. Regular blood tests to monitor platelet count and other vital signs help promptly detect and address any issues.

When Should I Talk to a Doctor?

If you are experiencing symptoms that may suggest Immune Thrombocytopenia (ITP), such as easy bruising, prolonged bleeding from cuts, spontaneous nosebleeds, or gum bleeding, it is crucial to schedule an appointment with your healthcare provider. Early diagnosis helps manage the condition effectively and prevent potential complications.

Uncontrolled bleeding is a medical emergency. If you or someone else with ITP is experiencing severe bleeding or symptoms like blood in urine or stools, heavy menstrual flow, or vomiting blood, seek immediate medical help. Managing ITP often involves a team approach, and your healthcare provider is essential to that team.

When Should I Talk to a Lawyer?

If you received a diagnosis of Immune Thrombocytopenia (ITP) that you believe is linked to vaccination, it might be time to consult with a vaccine injury lawyer.

The National Vaccine Injury Compensation Program (VICP) provides a means for individuals to seek compensation for vaccine-related injuries or illnesses, including ITP.

Acting early offers several advantages. Generally, you have up to three years to file a claim for non-fatal vaccine-related issues. Many vaccine-related injuries, including some cases of ITP, are presumed to be caused by the vaccine if they occur within a specific timeframe, according to VICP guidelines.

An experienced ITP vaccine injury lawyer will review your medical records and ensure they meet the requirements for a VICP claim without needing additional proof of causation. Early action also allows your lawyer to prepare your claim for the Vaccine Court, a crucial step in the VICP claims process.

Remember that VICP claims can be lengthy, so starting early can increase your chances of receiving prompt compensation. To maximize your financial recovery through VICP, work with your lawyer to thoroughly document medical expenses, income loss, and suffering related to your ITP diagnosis.