Second-line medical therapies include thrombopoietin receptor agonists, rituximab , fostamatinib , or other immunosuppressive drugs. More intensive immunosuppression may be required with drugs such as cyclophosphamide , cyclosporine , mycophenolate , and azathioprine in patients unresponsive to other drugs who have severe, symptomatic thrombocytopenia.
IV anti-D immunoglobulin is only effective in patients who have not had a splenectomy and may be associated with severe complications such as severe hemolysis and disseminated intravascular coagulation Disseminated Intravascular Coagulation DIC Disseminated intravascular coagulation DIC involves abnormal, excessive generation of thrombin and fibrin in the circulating blood. During the process, increased platelet aggregation and coagulation This treatment usually causes the platelet count to rise within 2 to 4 days, but the count remains high for only 2 to 4 weeks.
Patients with ITP and life-threatening bleeding are also given platelet transfusions. Platelet transfusions are not used prophylactically.
Vincristine 1. Treatment of children with immune thrombocytopenia is usually supportive because most children spontaneously recover.
Even after months or years of thrombocytopenia, most children have spontaneous remissions. If mucosal bleeding occurs, corticosteroids or IVIG may be given. Corticosteroid and IVIG use is controversial because the increased platelet count may not improve clinical outcome.
Splenectomy is rarely done in children. Blood Adv 3 23 —, Blood Adv 3 22 — Blood —, Am J Hematology —, The immune system destroys platelets in the circulation and at the same time attacks bone marrow megakaryocytes, thereby reducing platelet production. Other causes of isolated thrombocytopenia eg, drugs, alcohol, lymphoproliferative disorders, other autoimmune diseases, viral infections need to be excluded. Splenectomy is often effective but is reserved for patients in whom medical therapy is ineffective or those whose disease persists after 12 months.
From developing new therapies that treat and prevent disease to helping people in need, we are committed to improving health and well-being around the world. The Manual was first published in as a service to the community. Learn more about our commitment to Global Medical Knowledge. Because platelets help stop bleeding, the symptoms of ITP are related to increased bleeding. However, each person may experience symptoms differently.
Symptoms may include:. The symptoms of ITP may look like other medical problems. Always consult your health care provider for a diagnosis. Historically, a bone marrow aspiration was required to make a diagnosis of ITP.
It may not be absolutely necessary in the face of a positive antiplatelet antibody test, but it is still commonly done to look at the production of platelets and to rule out any abnormal cells the marrow may be producing that could lower platelet counts.
A bone marrow aspiration is necessary for a diagnosis if the antiplatelet antibody testing is negative. Specific treatment for idiopathic thrombocytopenic purpura will be determined by your health care provider based on:. When treatment is necessary, the two most common forms of immediate treatment are steroids and intravenous gamma globulin:. Health Home Conditions and Diseases. Thrombocytopenia means a decreased number of platelets in the blood.
Purpura refers to the purple discoloring of the skin, as with a bruise. ITP is a fairly common blood disorder that both children and adults can develop. There are two forms of ITP: Acute thrombocytopenic purpura. This usually affects young children, ages 2 to 6 years old.
The symptoms may follow a viral illness, such as chickenpox. Acute ITP usually starts suddenly and the symptoms usually disappear in less than 6 months, often within a few weeks. Treatment is often not needed. The disorder usually does not recur. Acute ITP is the most common form of the disorder. Chronic thrombocytopenic purpura. The onset of the disorder can happen at any age, and the symptoms can last a minimum of 6 months, several years, or a lifetime.
Adults have this form more often than children do, but it does affect adolescents. With this condition, the bone marrow is scarred and isn't able to make blood cells. People who are at highest risk for thrombocytopenia are those affected by one of the conditions or factors discussed in "What Causes Thrombocytopenia?
Whether you can prevent thrombocytopenia depends on its specific cause. Usually the condition can't be prevented. However, you can take steps to prevent health problems associated with thrombocytopenia.
For example:. Mild to serious bleeding causes the main signs and symptoms of thrombocytopenia. Signs and symptoms can appear suddenly or over time. Mild thrombocytopenia often has no signs or symptoms. Many times, it's found during a routine blood test.
Check with your doctor if you have any signs of bleeding. Severe thrombocytopenia can cause bleeding in almost any part of the body. Bleeding can lead to a medical emergency and should be treated right away. External bleeding usually is the first sign of a low platelet count.
Purpura are purple, brown, and red bruises. This bruising may happen easily and often. Petechiae are small red or purple dots on your skin. Purpura and petechiae in the skin. The photograph shows two types of bruising that are often seen with DIC.
The larger red, brown, and purple dots are purpura and the smaller red and purple dots are petechiae. Heavy bleeding into the intestines or the brain internal bleeding is serious and can be fatal. Signs and symptoms include:. Your doctor will diagnose thrombocytopenia based on your medical history, a physical exam, and test results. A hematologist also may be involved in your care. This is a doctor who specializes in diagnosing and treating blood diseases and conditions.
Your doctor will do a physical exam to look for signs and symptoms of bleeding, such as bruises or spots on the skin. He or she will check your abdomen for signs of an enlarged spleen or liver. You also will be checked for signs of infection, such as a fever. Your doctor may recommend one or more of the following tests to help diagnose a low platelet count. For more information about blood tests, go to the Health Topics Blood Tests article. A complete blood count CBC measures the levels of red blood cells, white blood cells, and platelets in your blood.
For this test, a small amount of blood is drawn from a blood vessel, usually in your arm. If you have thrombocytopenia, the results of this test will show that your platelet count is low. A blood smear is used to check the appearance of your platelets under a microscope. Bone marrow tests check whether your bone marrow is healthy. Blood cells, including platelets, are made in your bone marrow. The two bone marrow tests are aspiration as-pih-RA-shun and biopsy. Bone marrow aspiration might be done to find out why your bone marrow isn't making enough blood cells.
For this test, your doctor removes a sample of fluid bone marrow through a needle. He or she examines the sample under a microscope to check for faulty cells. A bone marrow biopsy often is done right after an aspiration. For this test, your doctor removes a sample of bone marrow tissue through a needle. He or she examines the tissue to check the number and types of cells in the bone marrow.
If a bleeding problem is suspected, you may need other blood tests as well. For example, your doctor may recommend PT and PTT tests to see whether your blood is clotting properly. Your doctor also may suggest an ultrasound to check your spleen.
An ultrasound uses sound waves to create pictures of your spleen. This will allow your doctor to see whether your spleen is enlarged.
Treatment for thrombocytopenia depends on its cause and severity. The main goal of treatment is to prevent death and disability caused by bleeding.
If your condition is mild, you may not need treatment. A fully normal platelet count isn't necessary to prevent bleeding, even with severe cuts or accidents. Thrombocytopenia often improves when its underlying cause is treated. People who inherit the condition usually don't need treatment.
If a reaction to a medicine is causing a low platelet count, your doctor may prescribe another medicine. Most people recover after the initial medicine has been stopped. For heparin-induced thrombocytopenia HIT , stopping the heparin isn't enough. Often, you'll need another medicine to prevent blood clotting.
If your immune system is causing a low platelet count, your doctor may prescribe medicines to suppress the immune system. If your thrombocytopenia is severe, your doctor may prescribe treatments such as medicines, blood or platelet transfusions, or splenectomy. The spleen is a small organ usually about the size of your fist. But a number of conditions, including liver disease and some cancers, can cause your spleen to become enlarged. Thrombocytopenia means you have fewer than , platelets per microliter of circulating blood.
Because each platelet lives only about 10 days, your body normally renews your platelet supply continually by producing new platelets in your bone marrow. Thrombocytopenia rarely is inherited; or it can be caused by a number of medications or conditions. Whatever the cause, circulating platelets are reduced by one or more of the following processes: trapping of platelets in the spleen, decreased platelet production or increased destruction of platelets.
The spleen is a small organ about the size of your fist situated just below your rib cage on the left side of your abdomen. Normally, your spleen works to fight infection and filter unwanted material from your blood. An enlarged spleen — which can be caused by a number of disorders — can harbor too many platelets, which decreases the number of platelets in circulation. Platelets are produced in your bone marrow.
Factors that can decrease platelet production include:. Some conditions can cause your body to use up or destroy platelets faster than they're produced, leading to a shortage of platelets in your bloodstream.
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