ITP Foundation's
Guide to Understanding ITP

As a collaborative effort between Dr. Paul Imbach and the ITP Foundation, the ITP Foundation's Guide to Understanding ITP was developed to educate individuals diagnosed with ITP, their families, friends, and caregivers. Please download and familiarize yourself with our informative document.

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Click on the image above to view the PDF

About the Author
Dr. Paul Imbach is the Intercontinental Cooperative ITP Study Group (ICIS) Chairperson for the Hematology/Oncology Unit of University Children's Hospital in Basel, Switzerland. He is also the resident Medical Advisory Director for the ITP Foundation.

What is ITP?

What is ITP?
What are the symptoms of ITP?
How is ITP Diagnosed?
Forms of ITP - Acute or Chronic, Primary or Seconday
How is ITP treated?
Document: ITP Foundation's Guide to Understanding ITP
Where can I obtain further information on ITP?


What is ITP?

ITP - Immune thrombocytopenia, also known as immune or idiopathic thrombocytopenic purpura, is a rare bleeding disorder characterized by a low amount of platelets in the blood. Platelets are needed for clotting of the blood. In patients with ITP, a person's own immune system creates antibodies that mark healthy platelets as "foreign substances" and then mistakenly attack and destroy them. As an autoimmune disease that results in the destruction of platelets, patients with ITP have a tendency to bleed or bruise.

Immune refers to the immune system's involvement in this disorder. Antibodies, part of the body's immunologic defense against infection, attach to blood platelets, cells that help stop bleeding, and cause their destruction. Thrombocytopenia refers to decrease in blood platelets. Purpura refers to the purplish-looking areas of the skin and mucous membranes (such as the lining of the mouth) where bleeding has occurred as a result of decreased platelet.

While some cases of ITP are caused by drugs and others are associated with infection, pregnancy, or immune disorders such as systemic lupus erythematosus, about half of all cases are classified as "idiopathic," meaning the cause is unknown.

What are the symptoms of ITP?

The main symptom is bleeding which can include bruising ("ecchymosis") and tiny red dots on the skin or mucous membranes ("petechiae"). In some instances bleeding from the nose, mouth and gums, digestive or urinary tracts may also occur. Rarely, bleeding within the brain occurs.

How is ITP diagnosed?

The physician will take a medical history and perform a thorough physical examination. A careful review of medications the patient is taking is important because some drugs can be associated with thrombocytopenia. A complete blood count (CDC) will be done to quantifying the numbers for each type of blood cells including platelets. A low platelet count will establish thrombocytopenia as the cause of purpura. Often the next procedure is a bone marrow examination to verify that there are adequate platelet-forming cells (megakaryocyte) in the marrow and to rule out other diseases such as metastatic cancer (cancer that has spread to the bone marrow) and leukemia (cancer of the blood cells themselves). Another blood sample may be drawn to check for other conditions sometimes associated with thrombocytopenia such as lupus and infection.

Forms of ITP - Acute or Chronic, Primary or Secondary

Acute (temporary) thrombocytopenic purpura is most commonly seen in young children. Boys and girls are equally affected. Symptoms often, but do not necessarily, follow a viral infection. About 85 percent of children recover within 1 year and the problem doesn't return.

Thrombocytopenic purpura is considered chronic when it has lasted more than 6 months. The onset of illness may be at any age. Adults more often have the chronic disorder and females are affected two to three times more than males. The onset of illness may be at any age.

Primary ITP, also know as Idiopathic, is when ITP develops for no known reason

Secondary ITP is associated with other illnesses such as an infection or autoimmune disease, or occur after transfusion or taking certain drugs, for instance cancer drugs.

How is ITP treated?

If the doctor thinks a drug is the cause of the thrombocytopenia, standard treatment involves discontinuing the drug's use. Infection, if present, is treated vigorously since control of the infection may result in a return of the platelet count to normal.

The treatment of idiopathic thrombocytopenic purpura is determined by the severity of the symptoms. In some cases, no therapy is needed. In most cases, drugs that alter the immune system's attack on the platelet are prescribed. These include corticosteroids (i.e., prednisone) and/or intravenous infusions of immune globulin (IVIG). Another treatment that usually results in an increased number of platelet is removal of the spleen, the organ that destroys antibody-coated platelet. Other drugs such as vincristine, azathioprine (Imuran), Danazol, cyclophosphamide, and cyclosporine are prescribed for patients only in severe cases where other treatments have not shown benefit, since these drugs have potentially harmful side effects.

Except in certain situations (e.g., internal bleeding and preparation for surgery), platelet transfusions usually are not beneficial and therefore, are seldom performed. Because all therapies can have risks, it is important that overtreatment (treatment based solely on platelet counts and not on symptoms) be avoided. In some instances lifestyle adjustments may be helpful for prevention of bleeding due to injury. These would include use of protective gear such as helmets and avoidance of contact sports in symptomatic patients or when platelet counts are less than 50,000. Otherwise, patients usually can carry on normal activities, but final decisions about activity should be made in consultation with the patient's hematologist.

** The ITP Foundation does not recommend any particular treatment. Prior to pursuing any course of treatment, consult your healthcare professional for advice on your unique medical condition

Exclusive - Document: ITP Foundation's Guide to Understanding ITP

As a collaborative effort between Dr. Paul Imbach and the ITP Foundation, the ITP Foundation's Guide to Understanding ITP was developed to educate individuals diagnosed with ITP, their families, friends, and caregivers. Please download and familiarize yourself with our informative document.

ITPF logo
Click on the image above to view the PDF

About the Author - Dr. Paul Imbach is the Intercontinental Cooperative ITP Study Group (ICIS) Chairperson for the Hematology/Oncology Unit of University Children's Hospital in Basel, Switzerland. He is also the resident Medical Advisory Director for the ITP Foundation.

Where can I obtain further information on ITP?

Blood specialists (hematologist) are experts in the diagnosis and treatment of these disorders. These doctors practice in most mid-and large-size cities. A majority of medical centers have hematology divisions in their medicine or pediatrics departments, and patients who need evaluation, treatment, or information can often be referred there.



Additional resources and information can be found in the RESOURCES section of our, the ITP Foundation's, website.

Additional information can be obtained from the National Organization for Rare Disorders at 55 Kenosia Avenue, PO Box 1968, Danbury, CT 06813-1968. Phone Number: (203) 744-0100. Tollfree: (800) 999-6673 (voicemail only). TDD Number: (203) 797-9590.

NIH Publication No. 90-2114 September 1990

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service National Institutes of Health National Heart, Lung, and Blood Institute



The entire ITP Foundation website and the contents thereof does not replace professional medical opinion, examination, diagnosis or treatment. Always seek the advice of a medical doctor or other qualified health professional before starting any new treatment or making any changes to existing treatment. The health questions and information on the ITP Foundation website should not be used to diagnose, treat, or prevent any disease without the supervision of a medical doctor.


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