Immune Thrombocytopenia

What is immune thrombocytopenia (ITP)?

Immune thrombocytopenia (ITP) is a bleeding disorder. Children with ITP may bruise or bleed easily because the disease destroys platelets in the blood. The condition is pronounced im-YOON throm-boh-syt-oh-PEE-nee-ah.

Platelets are the blood cells that help form clots to stop bleeding and close wounds. The immune system usually helps prevent and fight infection. In ITP, the immune system attacks and destroys the body’s platelets instead. This happens mainly in the spleen.

ITP is also called immune thrombocytopenic purpura or idiopathic thrombocytopenic purpura. 

  • Idiopathic (ih-dee-uh-PAAH-thik) means we do not know what causes it.
  • Thrombocytopenic means that there are not enough platelets in the blood.
  • Purpura means bruises in the skin. 

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 ITP.

  • We are not sure what causes ITP. 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 cannot catch ITP from someone else.

ITP at Seattle Children’s

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

Often ITP 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.

Please contact the center at 206-987-2106 for more information, a second opinion or to make an appointment.

  • Our doctors are nationally known for treating children who have blood disorders. The doctors who guide your child’s care have extra training and years of experience in giving the expert care your child needs. They constantly expand their knowledge about blood disorders and the latest research.

    We keep a careful watch on your child’s health. If your child needs treatment, we offer a full range of medicines and surgery to remove the spleen, if needed. We recommend the right treatment at the right time to have the best results for your child and your family.

    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.

  • Our specialty is treating children’s conditions while helping them grow up to be healthy and productive. For more than a decade, U.S. News & World Report has consistently ranked Seattle Children’s Cancer Center among the best in the nation. For 2019-20, it has the highest ranking in the Northwest.

    Children don’t react to illness, injury, pain and medicine in the same way as adults. They need – and deserve – care designed just for them.

    Our doctors have special training in how to diagnose and treat children with blood disorders. Our experts base their treatment plans on years of experience and the newest research on what works best – and most safely – for children.

  • 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 or blood in their bowel movements (stool) or pee (urine). Some children need to stay overnight in the hospital for treatment. If needs are not urgent, new patients can be seen within a week.

    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.

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 right treatments at the right time. Treatment does not cure ITP, but it will often increase the number of platelets. Most treatments slow down 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 on weekends.

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:

  • 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 lasting longer than 5 minutes
    • Blood in pee or bowel movements (stool)
    • Bleeding from the gums
    • Severe headache
  • We help you and your child lower the risk of bleeding problems.

    Your provider will 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, including aspirin and ibuprofen (such as Advil). Your child’s doctor can give you details about which medicines to avoid. 

    Call your provider if your child has these signs of bleeding problems: 

    • Bowel movements (stools) 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 

    To call your 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.”
  • Steroids (such as prednisone or dexamethasone) decrease antibody production and may help slow down how fast the spleen removes platelets from the blood. Usually, your child takes these medicines by mouth.

    If your child gets this treatment, their team will talk with you about how to manage side effects, such as: 

    • Weight gain
    • Feeling hungrier than usual
    • Upset stomach
    • Feeling moody
  • 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 blood plasma (the liquid part of blood) from healthy donors.

    Children who need IVIG usually stay overnight in the hospital. We watch your child for side effects that happen in some children. These include nausea or headache.

  • If your child’s ITP is very serious or long lasting, your doctor will talk with you about other medicines. Some are taken by mouth, and some are given by an injection.

    Your doctor may recommend 1 or more of these: 

    • Mercaptopurine
    • Azathioprine
    • Mycophenolate mofetil
    • Eltrombopag
    • Romiplostim
    • Rituximab
  • If your child’s ITP is severe and medicine is not working, your 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 doctor will explain how to help avoid infections, such as getting extra immunizations. Your team will tell you what symptoms to watch for.

  • We usually check your child’s platelet count at each clinic visit. Your provider will talk with you about other times your child’s platelet count should be checked, such as: 

    • After any treatment for bleeding, we check your child’s platelets within a week.
    • If your child’s platelets are less than 10,000 within the first few weeks of diagnosis or are decreasing quickly, we measure all of their blood cells each week.
    • If your child’s platelets are greater than 10,000, we will check platelets only if they have symptoms. 

    When the platelet count is normal (above 100,000) or close to normal and stable, we can stop checking. But your child’s platelet count should be checked again if: 

    • New symptoms start
    • Problems like gum bleeding or nose bleeding happen again 

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

Contact Us 

If you would like an appointment, ask your child’s primary care provider for a referral.

If you have a referral or would like a second opinion, call the Cancer and Blood Disorders Center at 206-987-2106.

Providers, see how to refer a patient.