Immune thrombocytopenia (ITP) is a blood platelet disorder. For some people, the condition can cause serious complications if left untreated. If you understand the signs and symptoms of ITP complications, ITP can be managed with appropriate treatment and lifestyle changes.

ITP can cause abnormal bleeding and bruising due to low platelet counts. Platelets are small blood cells that stick together where blood vessels are damaged. If you don’t have enough platelets, blood cannot properly clot to stop bleeding. ITP is an autoimmune disease caused by dysfunction in the immune system, which attacks blood platelets with antibodies.

ITP is also known as immune thrombocytopenic purpura or idiopathic thrombocytopenic purpura. The condition can occur in children after a viral infection, and it often goes away on its own without treatment. Adults are more likely to develop chronic ITP. Risk factors for ITP include bacterial or viral infections, the use of antibiotics or antiviral medication and, rarely, some vaccines like measles, mumps, and rubella (MMR).

What Are the Signs of ITP?

ITP can initially be asymptomatic, or show no obvious symptoms. Sometimes, it’s only discovered by chance when someone takes a blood test for other reasons. ITP is diagnosed with a complete blood count, a blood smear to examine platelets under a microscope, and in some cases, a bone marrow test to rule out other blood disorders.

Sometimes, a person’s platelet count will have already dropped considerably before ITP is recognized and diagnosed. Treating ITP as early as possible can help prevent complications. Symptoms that indicate a complication of ITP should be reported to your doctor right away. Here are five signs of ITP to be aware of.

1. Easy Bruising

Bruises develop when bleeding occurs under the skin from some kind of hard impact. People with ITP may develop large bruises from ordinary activities. Bruises may appear on the elbows and knees in particular, but they can occur anywhere on the body. Bruises called purpura can also develop due to bleeding from blood vessels under the skin. They may appear purple or brown, depending on skin tone.

2. Bleeding Within the Skin

With ITP, your skin can develop tiny red or discolored spots called petechiae. They may look like a rash, but they’re actually a type of superficial bleeding in the skin. Petechiae do not itch like a typical rash, which is an important sign that they may be a complication of ITP. Petechiae often appear on the lower legs.

3. Excessive Bleeding

Nosebleeds and bleeding gums can easily be overlooked as common occurrences, but they may persist in untreated cases of ITP. Rectal bleeding or blood in the urine, stool, or vomit is a sign of internal bleeding in the gastrointestinal system or urinary tract, and this may also indicate ITP.

4. Heavy Menstruation

People with ITP may have heavier than usual menstrual periods. Menstrual bleeding that lasts more than seven days or has thick blood clots should be discussed with your doctor. If you need to change a menstrual pad or tampon more than once in two hours, that is also a sign of abnormally heavy bleeding and could indicate ITP or another serious condition.

Heavy menstrual bleeding can cause anemia in people with ITP, although anemia can also occur from other bleeding due to ITP. Be aware that anemia can cause fatigue.

5. Bleeding in the Brain

In rare and very serious cases of ITP, bleeding can occur in the brain. This is a life-threatening complication of ITP. Contact your doctor immediately if you have signs of a brain bleed (intracranial hemorrhage), including:

• Sudden numbness or tingling in the face, legs, or arms, often on one side of the body
• Headache, which may come on suddenly
• Confusion, dizziness, or loss of consciousness
• Problems with vision, balance, speaking, swallowing, or breathing

How Can You Manage ITP Complications?

People with ITP can take steps to manage their care by understanding treatment options and lifestyle changes that can help. If you’re living with ITP, here are six strategies to try.

1. Discuss Treatment Options With Your Doctor

If you or your child has been diagnosed with ITP, talk openly with your hematologist about any concerns you may have about your medical care. The American Society of Hematology recommends you and your doctor engage in shared decision-making in the treatment of ITP to ensure that your quality of life, values, and priorities are carefully considered.

Discuss treatment options in detail with your doctor. Some people with ITP who aren’t having symptoms might not need any treatment, although it is important to still monitor the condition. The most common first-line treatment for ITP is short-term use of glucocorticoids (such as prednisone or dexamethasone). Intravenous immunoglobulin is also an option.

If these prove ineffective, your doctor will recommend second-line treatment. Second-line options include:

• Thrombopoietin-receptor agonists — Romiplostim (sold under the brand name Nplate), eltrombopag (sold under the brand name Promacta), and avatrombopag (sold under the brand name Doptelet) are drugs that promote platelet production in bone marrow.
• Spleen tyrosine kinase inhibitors — Fostamatinib (sold under the brand name Tavalisse) is the first drug of this type to be approved for chronic ITP. It works by preventing the body’s immune system from attacking platelets.
• Rituximab — Sold under the brand name Rituxan, rituximab is an immunosuppressive biologic therapy.

When ITP continues to be a health danger despite these options, surgery to remove the spleen (splenectomy) may be considered.

Your doctor can help you understand whether your ITP requires treatment, as well as the potential benefits and risks of each of these treatment options.

2. Schedule Monitoring and Follow-up Care

People with chronic ITP will need ongoing monitoring that may include periodic blood tests to analyze blood cell health. If you are taking medication for ITP, you will need to be monitored for rare but serious side effects. Sticking to a treatment plan and follow-up care is essential for staying healthy with chronic ITP.

Be sure to keep your health care team informed about your symptoms, and don’t hesitate to contact your doctor if you think you or your child is having a serious symptom. ITP is associated with many comorbidities — coinciding health conditions — and it’s crucial to get regular check-ups along with your ITP care.

3. Reduce Your Risk of Bleeding

People with ITP are advised to avoid contact sports that have a risk of injury, such as football, martial arts, and boxing. Activities with an increased risk of falling, such as skiing or bicycle riding, can also be hazardous for people living with ITP and should be avoided.

Young children with ITP can benefit from appropriate protective gear, such as knee pads, helmets, and padding on furniture, to help them avoid injuries during their daily activities that could cause bleeding or bruising.

4. Adopt a Healthy Diet

Experts believe a healthy diet can help support immune health. Eating more fresh fruits and vegetables, such as leafy greens, provides needed nutrients. Healthy fats, such as cold-pressed olive oil and canola oil, are good for your overall health.

Always talk to your doctor before taking herbal or dietary supplements to determine if supplements are right for you and to understand appropriate dosage. Some supplements may interact poorly with ITP medications. Other supplements may have an adverse effect on platelets and blood clotting.

You can gradually try eating a more healthy diet rather than making big changes all at once. Your doctor can provide a referral to a dietitian to help you with healthy meal planning.

5. Stay Physically Active and Exercise Safely

People with ITP may feel frustrated by precautions that limit their physical activity. But you can work with a physical therapist to learn ways to exercise safely and stay physically active.

Exercise can relieve fatigue and uplift your mood while helping you stay physically fit. Research shows that resistance training is safe for people with ITP, including using elastic bands. Range-of-motion exercises, stationary cycling, and walking are also good choices.

6. Pay Attention to Your Psychological Well-Being

ITP can be emotionally challenging and interfere with daily life. People living with ITP have an increased risk of depression and anxiety. Mental health is an important part of maintaining a sense of well-being.

If you or someone you are caring for with ITP has persistent feelings of anxiety or depression, reach out to your health care provider. They can refer you to a mental health counselor who can help manage the emotional toll and stress of living with ITP.

Talk With Others Who Understand

On myITPcenter, the site for people with immune thrombocytopenia and their loved ones, people come together to gain a new understanding of ITP and share their stories with others who understand life with ITP.

What complications from ITP did you first notice? How are you managing your ITP? Share your advice in a comment below.