ITP Symptoms: Bruising, Petechiae, Nosebleeds, and More

Immune thrombocytopenia (ITP), a rare bleeding disorder characterized by low platelet counts in your blood, can make it difficult for your blood to clot. Because blood clotting is a key part of the injury-healing process, low platelet counts can lead to unexpected or excessive bleeding and bruising.

This article provides an overview of common symptoms of ITP, including those impacting the skin, the mucosal tissue, and the body as a whole.

When ITP Doesn’t Cause Symptoms

It’s possible to have ITP and have no symptoms at all. Between 30 percent and 40 percent of people with chronic ITP have no bleeding symptoms.

If you’ve never had ITP symptoms, you might have first found out you have the condition after a blood test you got for another reason. A blood test called a complete blood count (CBC) can tell you if you have a low platelet count.

A low platelet count isn’t the only predictor of bleeding in ITP — your age, kidney problems, contact sports, and other factors can increase your risk of bleeding symptoms.

Being asymptomatic doesn’t mean you won’t have symptoms in the future. If you do develop symptoms, you may need multiple tests to rule out other causes of low platelets or abnormal bleeding. ITP is diagnosed after other possible causes have been considered.

Skin Symptoms of ITP

Symptoms of ITP that appear on your skin are some of the easiest to spot. They include signs of bleeding both on the skin itself and bleeding that occurs in tissues just under your skin. You might mistake certain ITP skin symptoms for a rash, but, unlike many rashes, these symptoms are not itchy.

Petechiae

Petechiae are a type of skin sign that most often appears on the lower legs in people with ITP. They’re what you see when capillaries, or tiny blood vessels, break under your skin. They’re microscopic spots of bleeding just under your skin’s surface.

Similar to many rashes, petechiae typically look like tiny dots that may be red, purple, or brown depending on your skin tone. However, whereas a rash turns lighter when you press on it, petechiae stay the same color. They’re also flush with your skin — not rough, raised, or bumpy.

Purpura

While petechiae are tiny spots of bleeding, another ITP symptom called purpura can form when many tiny spots blend together to form larger spots. Purpura also develops because of small broken capillaries leaking blood.

Purpura is different from a bruise because it’s smaller. However, purpura can have similar coloring to petechiae or bruises. The spots can appear red, brown, or purple depending on your natural skin tone.

Bruising

Bruising occurs when a significant amount of blood pools under your skin to form a mark. The mark changes color as the bruise heals, with colors ranging from black to bluish purple to brown or yellow.

If you have ITP, you may bruise very easily with little or no impact to the skin. You might see ITP bruises without knowing how you got them or when they first appeared.

Mucosal and Internal Bleeding Symptoms

ITP can cause bruising in mucosal tissues, which are moist tissues lining different body parts and canals, like your gastrointestinal tract (GI tract) or lungs and airways. While bleeding in mucosal tissues won’t be visible like bruises or petechiae, you may notice other evidence.

Nosebleeds

Frequent nosebleeds can be a sign of bleeding in your nose or sinuses. Nosebleeds from ITP can be heavy, so they may not be like nosebleeds you’ve seen before. Tell your or your child’s doctor if you or your child experiences nosebleeds often, especially if they occur after a recent illness.

Bleeding Gums

Bleeding gums are another indication of mucosal bleeding. While gum bleeds can also indicate dental problems like gingivitis or gum disease, swollen and bleeding gums may be related to ITP instead if you don’t have these conditions. Your gums may bleed spontaneously or while brushing your teeth.

Heavy Menstrual Bleeding

Low platelet counts in ITP can lead to heavy menstrual bleeding, or periods that are heavier or more prolonged than usual. Tell your doctor if your periods:

• Last longer than seven days
• Require hourly tampon or pad changes
• Prevent you from working or leaving the house
• Involve more than 5 tablespoons of blood loss (normal is 2 to 3 tablespoons)

Heavy menstrual bleeding isn’t always caused by ITP or another blood disorder — up to 54 percent of people who have periods bleed heavily, and heavy periods can have many causes. Your doctor will consider this symptom alongside other ITP symptoms while evaluating you.

Blood in Urine or Stool

Mucosal bleeding in ITP can lead to blood in your urine or stool. Although it can occur with severe ITP, other medical conditions can also cause these symptoms. This should be reported to your doctor right away because it requires prompt evaluation.

You may see red clearly in the toilet, or the signs of bleeding in urine or stool can be a bit more subtle:

Blood in Stool

It can be hard to see blood clearly in your stool. Bloody stool may not appear red at all — instead, your stool may be black or very dark.

Blood in Urine

Blood cells in your urine can tint it a pale orange or pink color. Tell your doctor if you notice any blood in your urine.

Fatigue and Other Systemic Symptoms

Systemic symptoms aren’t limited to just one body part, like your skin or mucosal tissue. Instead, these symptoms affect your whole body.

Fatigue

Many people with ITP experience fatigue or excessive tiredness that doesn’t get better with relaxation or sleep. Fatigue from ITP can have a significant impact on your quality of life and ability to function normally.

ITP treatments that increase platelet counts can help reduce fatigue. However, if your fatigue is intense, your doctor may recommend strategies that directly target the fatigue alongside treatments for the underlying ITP.

Anemia

Too much blood loss from ITP can lead to anemia, which occurs when you lose too much hemoglobin (a protein in red blood cells that transports oxygen to all of your organs and tissues). If you’re anemic, you may notice signs of anemia such as:

• Pale skin
• Dizziness
• Increased fatigue or tiredness
• Weakness
• Irregular heartbeat
• Cold hands and feet

ITP Treatment Side Effects

Although ITP treatments can be highly effective for increasing platelets and reducing platelet breakdown, some can cause side effects. Some treatment side effects may be intense and possibly pose more health risks than your ITP symptoms. Tell your doctor if you experience any of the following in response to ITP treatments:

• Diarrhea
• Fever and chills
• Nausea
• Headaches
• Vomiting (which may contain blood)

When To Seek Emergency Care for ITP Symptoms

In rare cases, ITP may lead to uncontrollable bleeding or other complications that require emergency care. You should seek emergency care anytime you can’t control your bleeding with pressure, as it can be a sign that your platelet count has dropped too low.

An intracranial hemorrhage or brain bleed is a rare but life-threatening complication of ITP, affecting less than 1 percent of people with ITP. It’s more common in children than adults, with very few adult cases ever reported. Seek emergency care right away if you notice signs of a brain bleed such as:

• Slurred words while talking
• Confusion
• A sudden and severe headache
• Numbness or paralysis on one side of the body
• Dizziness or trouble balancing
• Nausea and vomiting

Join the Conversation

On myITPteam, people share their experiences with immune thrombocytopenia, get advice, and find support from others who understand.

What were some of your first ITP symptoms? Let others know in the comments below.