Immune thrombocytopenia (ITP) is a condition in which antibodies are produced against platelets. An immune response against platelets leads to their destruction and a low platelet count (thrombocytopenia). The condition also features impaired platelet production.
Presentation
ITP most commonly occurs between 2 and 7 years of age. There is often a history of a recent viral illness. Presenting features include:
- Abnormal bleeding (e.g., gum bleeding, epistaxis or menorrhagia)
- Unexplained bruising
- Petechial or purpura
TOM TIP: Non-blanching lesions are caused by bleeding under the skin. The name depends on the size:
- Petechiae are pin-prick spots (around 1mm)
- Purpura are larger (3 – 10mm) spots
- Ecchymosis affects large areas (over 10mm)
Management
A full blood count is the initial investigation. This shows a low platelet count. Haemoglobin and white cell counts are usually normal.
Management may be conservative, with close monitoring until the platelet count improves. Remission typically occurs within 3-6 months. A small number will develop chronic ITP.
Treatment may be required where there is active bleeding, severe thrombocytopenia or chronic ITP. Treatments include:
- Prednisolone
- IV immunoglobulins
- Rituximab (for chronic ITP)
- Splenectomy (for chronic ITP)
- Blood transfusions (if required following major blood loss)
- Platelet transfusions (if required in life-threatening bleeding)
Platelet transfusions have only a temporary effect, as antibodies will quickly destroy the transfused platelets.
Precautions in patients with thrombocytopenia include:
- Avoiding contact sports
- Avoiding intramuscular injections and procedures such as lumbar punctures (depending on the platelet count)
- Avoiding NSAIDs, aspirin and blood-thinning medications
- Advice on managing nosebleeds
- Seeking help after any injury that may cause internal bleeding (e.g., car accidents or head injuries)
Last updated March 2026
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