Pediatric Idiopathic Thrombocytopenia Purpura (ITP)

ITP is a blood disorder that causes a decrease in the number of platelets in the blood. Platelets help stop bleeding. So a decrease in platelets can result in easy bruising, bleeding gums, and bleeding inside the body. The lower the platelet count, the greater the risk of bleeding. 

ITP may be acute or chronic:

• Acute thrombocytopenic purpura. This type is most common in young children (two to six years old). The symptoms may follow common viral illnesses. Acute ITP usually starts very suddenly. Symptoms often go away in less than six months (often within a few weeks). Treatment is not usually needed. The disorder typically does not recur. Acute ITP is the most common form of the disorder.
• Chronic thrombocytopenic purpura. This disorder can start at any age. The symptoms last at least 12 months. Adults have this form more often than children, but it does affect teens. Females have it two to three times more often than males. Chronic ITP can recur often.

Experienced hematologists at Children's National Hospital treat 25 patients with idiopathic thrombocytopenic purpura (ITP) annually in the Comprehensive Hemostasis and Thrombosis Program.

Children’s National's Division of Hematology is dedicated to finding new and more effective therapies by participating in clinical trials sponsored by the National Institutes of Health.

In addition, the Patient and Family Support Program provides comprehensive mental health and psychosocial services and helpful resources for all patients treated in the Cancer and Blood Disorders Center, as well as patients’ parents and siblings.

In most cases, the cause in children is unknown. Known causes include:

• Immune system problems
• Viral infections
• Some medicines or vaccines

The symptoms of ITP are related to increased bleeding. Some children have very mild symptoms or none at all. Symptoms may include:

• Purpura. This is the purple color of the skin after blood has "leaked" under it.
• Bruising. A bruise is blood under the skin. Children may have large bruises from no known injury. Bruises can appear on the elbows and knees just from movement.
• Petechia. Tiny red dots under the skin that are a result of very small bleeds.
• Nosebleeds
• Bleeding in the mouth or in and around the gums
• Blood in urine or stool
• Heavy menstrual bleeding (period) that is unusual.
  
• Vomiting with blood
• Bleeding with a head injury. This may be life-threatening in a child with ITP.
• Internal bleeding. If the platelet count is very low, there is a risk for internal bleeding, such as in the brain or the belly (abdomen).

The symptoms of ITP may look like other health problems. Always check with your child's doctor for a diagnosis.

Your child's doctor will ask questions about your child's medical history and do a physical exam. Other tests may include:

• Complete blood count or CBC. A complete blood count checks the red and white blood cells, platelets, and sometimes, young red blood cells. It also includes more details about the red blood cells. Normal platelet count is between 150,000 per microliter to 450,000 per microliter. With ITP, the platelet count is less than 100,000 per microliter. Children with ITP often have a platelet count of less than 10,000 per microliter. 
• Peripheral smear. A small sample of blood is examined under a microscope. Blood cells are checked to see if they look normal or not.
• Bone marrow aspiration. This test is very rarely needed. It looks at the production of platelets and rules out any abnormal cells the marrow may be making that could lower platelet counts.

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how bad the condition is.

Your child's doctor will likely refer you to a hematologist, an expert in blood disorders. Not all children with ITP need treatment. Most children recover without treatment. Blood tests to keep track of platelet levels and protection from bleeding may be all that is needed.

When treatment is needed, the two most common forms are steroids and immune globulin:

• Corticosteroids. Brief treatment with steroid medicine helps prevent bleeding by decreasing platelet destruction. Steroids can increase the platelet count in 2 to 3 weeks.
• Intravenous immune globulin (IVIg). A single dose of IVIg helps slow the destruction of platelets. It works more quickly than steroids (within 24 to 48 hours).
• Anti-D or Rh immune globulin. This medicine stops the spleen from destroying platelets in the short term. It's used very carefully because it may destroy red blood cells.

Other treatments for ITP may include:

• Medicines that promote platelet production.
• Rituximab. This is a type of antibody that helps to increase platelets by keeping them from being destroyed.
• High-dose dexamethasone. This is a type of steroid.
• Splenectomy. This is surgery to remove the spleen. This treatment may be done because the spleen is where most platelets are destroyed.

Problems from ITP include:

• Serious bleeding
• Complications from medicines used to treat ITP. Ask your child's doctor about medicine side effects.

To prevent bleeding:

• Talk with your child's doctor about which activities are safe when your child's platelet count is low.
• Make sure your child wears a helmet and other protective pads when bike riding, skating, or skateboarding.
• Don't let your child take part in contact sports like soccer, football, rugby and wrestling, as well as other high-injury activities.
• Don't give your child aspirin, ibuprofen, or other nonsteroidal anti-inflammatory drugs that increase the chance of bleeding.

Talk with your child's doctor about other ways to prevent injuries.

Call your child's doctor if your child has symptoms of bleeding that have gotten worse.