Immune Thrombocytopenia (ITP) (previously called “idiopathic thrombocytopenia”) is a condition where the platelets, which are small blood cells that are important to help the blood clot, are reduced because they are attacked and removed by the body’s immune system. This leads to a tendency to bruise and bleed. ITP affects 1000 children each year in Gujarat.

What causes ITP?

ITP results from the body making antibodies against platelets that attack and remove them from the bloodstream, the main site of destruction being the spleen. In some children this may follow a viral illness (for example, EBV) but most often the cause is unknown. ITP is neither inherited, nor can it spread from one child to another in the family, or amongst playmates.

What are the symptoms of ITP?

ITP often presents dramatically with bruising that covers the body, and tiny red dots on the skin (petechiae). Sometimes nosebleeds, bleeding from the mouth and bowels can occur. Very rarely (around 1:1000 patients) life-threatening bleeding, such as bleeding into the brain occurs.

How is ITP diagnosed?

Usually these are healthy children without fevers, spleen enlargement, or bony aches and pains. The sudden onset of bruising/bleeding in an otherwise well-looking child is suspicious for ITP, and the blood tests listed below are often enough to make a diagnosis

  • Complete Blood Count (CBC) is a blood test that measures all the circulating blood cells, and should show decreased platelets with a normal red and white cell count. A normal platelet count is usually 150,000 to 400,000/mm3 , but in ITP the counts can be 5000/mm3 or less which the CBC machine may struggle to count accurately
  • Peripheral blood smear is a test where a trained pathologists looks at the blood under a microscope. This is extremely helpful as new platelets, being produced as the older ones are destroyed by antibodies, are large enough for the CBC machine to mistake as red cells but can be easily counted under the microscope. It is important to exclude other diseases that can cause low platelets and review of the blood smear can pick up any other blood cell abnormality

In children who have any abnormalities in their blood count or smear, or whose history or exam is atypical, your doctor may need to do a test called a bone marrow aspirate to exclude other blood diseases.

How is IDA treated?

Any underlying cause should be addressed such as nutritional deficiencies, excessive menstrual blood loss etc. IDA itself is treated with iron syrup or tablets, or sometimes with IV iron. Blood transfusion should not be routinely needed. Oral iron supplementation should continue for 3-6 months to replenish body iron stores.

What is the outcome in ITP patients?

  • Newly Diagnosed ITP (60-70% children) is temporary and lasts for less than 3 months. It is the most common form of ITP in children.
  • Persistent ITP (10-20% children) disappears 3-12 months after diagnosis
  • Chronic ITP (10-20% children) lasts over 12 months and is more common in adults.