Is ITP Dangerous? Bleeding Risks and Red Flags

Low levels of blood platelets may not be something you realize you have unless you have symptoms like easy bruising or bleeding gums. But symptoms of immune thrombocytopenia (ITP) and similar bleeding disorders aren’t always mild. ITP and other bleeding disorders can sometimes cause bleeding that requires emergency care.

If you have ITP, you’re at an increased risk of uncontrolled or dangerous bleeding because your immune system destroys the platelets in your blood that normally stick together to stop bleeding.

It’s important to be aware of dangerous complications from ITP and to know when it’s time to get emergency care. In this article, we’ll discuss the main risks and red flags of ITP.

What Can Increase Your Bleeding Risk With ITP?

It’s easy to see how a low platelet count would increase the risk of bleeding in ITP. However, platelet count isn’t the only factor that can increase your risk of dangerous or even life-threatening bleeding. Several factors regarding your health can influence your ITP bleeding risk.

Platelet Count

Platelet count describes the number of platelets in your blood based on how many are counted in a blood sample. A complete blood count (CBC) can show whether you have a low platelet count. A low platelet count alone cannot confirm ITP, so doctors will check for other possible causes.

Here’s a general breakdown of what platelet count levels can mean for an adult:

• Low platelet count — Less than 150,000 platelets per microliter of blood
• Normal platelet count — About 150,000 to 450,000 platelets per microliter of blood
• High platelet count — More than 450,000 platelets per microliter of blood

Normal ranges can vary slightly from one laboratory to another.

Generally, a lower platelet count means a higher risk of bleeding symptoms related to ITP. However, it’s possible to have a platelet count approaching the normal range and still have ITP-related bleeding. Other factors, such as certain medications, other health conditions, platelet function, and a history of bleeding, may also affect the risk.

Bleeding Symptoms

Often, episodes of major bleeding are hard to predict. You may only have mild ITP symptoms for a long time before a major bleeding event occurs, so an emergency may come as a surprise. Many people with low platelet counts, including those caused by ITP, don’t have any symptoms.

Your Age

Older adults may be at an increased risk of serious complications with ITP. Research suggests that being 60 or older is a risk factor for severe bleeding in ITP. This is especially true for organ bleeding and episodes of major bleeding.

Age only slightly increases the risk of skin bleeding, such as petechiae (tiny red or purple spots) and purpura (larger purple patches). It also slightly increases the risk of bleeding from moist tissues, such as nosebleeds and bleeding gums.

Medications and Substances That Increase Bleeding

Some drugs, substances, and medications can interfere with the activity of your platelets and might increase the risk of major bleeding and other ITP complications. This includes some herbal agents and supplements. You may be at an increased risk of bleeding events if you take:

• Selective serotonin reuptake inhibitors (SSRIs)
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Anticoagulants
• Ginkgo biloba
• Alcohol

People who take multiple medications may also be at an increased risk of bleeding events in ITP, especially those who take NSAIDs and anticoagulants.

Other Medical Conditions

Other medical conditions you have with ITP may put you at an increased risk of episodes of major bleeding. Some complications of ITP are more likely to occur if you have cardiovascular diseases or other conditions including:

• Diabetes
• High cholesterol
• High blood pressure
• Atrial fibrillation
• Heart disease
• Valvular disease
• Obesity
• Cancer

Medical Procedures and Surgery

Certain medical procedures can increase your risk of uncontrolled bleeding when you have ITP. Your doctor may caution you about surgeries and some minor procedures, including some dental procedures, because it can be difficult to predict bleeding events based on your platelet count.

High-Risk Lifestyles

Engaging in risk-taking behaviors or certain occupations might increase your risk of major bleeding events with ITP. Contact sports, motorcycle riding, and working with heavy machinery are all examples of lifestyle factors that increase the risk of physical trauma, which can lead to uncontrolled bleeding in some cases.

Complications That Require Immediate Medical Attention

ITP can cause major complications that need immediate medical care. When complications occur, they often require a trip to the emergency room instead of a regular doctor’s appointment. It’s important to recognize the signs of ITP complications so you can take action when you need to.

Uncontrollable Bleeding

Uncontrollable bleeding can happen in various parts of your body, including your gastrointestinal tract (GI tract) and other internal organs where bleeding isn’t immediately obvious. Most people with ITP have no bleeding or only minor bleeding. Serious bleeding, including internal bleeding, is uncommon.

External bleeding can happen after an injury if you have a low platelet count from ITP. Apply firm pressure to the wound. If the bleeding doesn’t stop, go to the emergency room or call 911.

Uncontrollable bleeding can also happen after surgeries or medical procedures, including childbirth and dental procedures. It’s important to tell your surgeon or medical team about your ITP before any procedure or surgery. If you plan to become pregnant, talk to your doctor about how ITP may affect pregnancy.

Head Injuries

Head injuries are especially serious for people with ITP. Bleeding in or around the brain is a rare but life-threatening complication of ITP. The risk differs based on a person’s age, platelet count, health, and bleeding history.

Brain bleeds with severe ITP can be spontaneous, meaning they don’t have a clear cause such as an obvious injury. You should call 911 or your local emergency number right away if you notice any signs of a brain bleed:

• A sudden and severe headache
• Unexplained vomiting
• Light sensitivity
• Sudden numbness or weakness on one side of your body
• Confusion
• Slurred speech
• Balance problems and dizziness
• Possible loss of consciousness

Thromboembolism

Thromboembolism is a rare complication of ITP. Instead of bleeding, thromboembolism involves a blood clot that blocks blood flow. A clot can form in a vein or artery.

People with ITP can have a higher risk of blood clots even though their platelet counts are low. The risk varies from person to person and may be affected by age, other medical conditions, removal of the spleen (splenectomy), and certain ITP treatments.

When a blood clot blocks blood flow to specific organs, emergency complications can occur. For example, clots in arteries can cause a heart attack or ischemic stroke. Clots in veins can cause conditions such as deep vein thrombosis or a pulmonary embolism.

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