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About ITP (16)

Early Detection and Prevention No one knows what causes the immune system to mount an attack on platelets and, unfortunately, there is nothing we know that can definitively prevent the onset of ITP. There are, however, several signs and symptoms that may indicate ITP and, when directly defined, may assist in early detection. Possible early indicators of ITP are listed below along with several tips for living a healthy lifestyle in an effort to assist with prevention. There are many treatments for ITP and some people go into remission, but there is no cure for ITP. With increased awareness, education, and research there remains hope.

PDSA has hundreds of pages on this website to help you better understand the disease. Click on all the links.

Early Detection

Understand Normal Platelet Counts and Potential Causes of Low Platelets
1. Test your platelet count with an annual complete blood count (CBC)
2. See a hematologist if the results show a platelet count below 100,000
- A normal platelet count is 150,000 – 400,000
- Together with your hematologist, determine if your low platelet count may be caused by a new drug you have taken, an infection, an exposure to toxins, or something you ate. For more information visit Diagnosing ITP.
- Familiarize yourself with drugs and other substances known to lower platelet counts. See: Warnings
3. Check to see if others in your family have low platelets. If they do, you may have an inherited low-platelet disease. See ITP and Families

Know the Possible Signs and Symptoms of Low Platelets
Signs (things you see)

1. Petechiae – small, reddish-purple spots that look like a rash, but are not raised
2. Bruising or purpura - dark red or purple bruises (black and blue marks) with no known cause
3. Any bleeding that may be unusual, heavier, or lasting longer than usual
- Heavy menses in women
- Frequent, heavy, or persistent nosebleeds
- Bleeding inside the mouth on the cheeks (blood blisters) or from the gums with no known cause
- Blood in urine or stool

Symptoms (things you feel)
1. Fatigue
2. Depression

 

Prevention

Maintain a Healthy Diet and Lifestyle
1. For a helpful list see PDSA’s Diet and Lifestyle suggestions
2. Maintain a healthy digestive system and reduce inflammation (associated with ITP) by eating a whole foods diet and chewing your food well. See Food as a Cure
3. Maintain adequate levels of both folic acid and vitamin D. See: “Living with ITP: Answers to Common Questions” . (Be sure to work consult your doctor before taking any supplements.)
4. Make an effort to reduce your stress level.  Find information about the methods and benefits of reducing stress on the Mind Body Medicine page.
5. Avoid environmental toxins and other substances that can cause low platelets. See About ITP: Warnings


 

A Study to Investigate the Efficacy and Safety of S-888711 Tablets Administered to Adult Subjects With Immune Thrombocytopenia.

While no one knows the precise cause of ITP at this time, researchers continue to make progress in understanding it and the similarities to other autoimmune diseases.  Since ITP can vary greatly between individuals, causes of ITP may also vary. Note that the theories on this page are listed separately (in alphabetical order), however they most likely overlap.  For example, someone may have a defect in immune regulation which makes them more susceptible to developing ITP after an immunization or contracting H. pylori.

Bacteria and Virus Byproducts

This theory suggests that ITP (and other autoimmune diseases) may be caused by a person’s immune response being confused between its own cells and invading virus and bacteria.

When a virus or bacteria invades our body, special cells chop it up into thousands of fragments and put some of these fragments in a type of pocket for the immune system to disable.  T-cells (a type of white blood cell) latch on to the fragments in the pocket and send signals to destroy all of the tissues that have the same or similar makeup.  The problem comes when the fragment to be destroyed looks like part of a platelet.  In that case, antibodies attach to platelets as well as the fragments on other cells resulting in both the invaders and the platelets being destroyed.

In a similar theory, when our body is fighting a reaction, it produces a compound called interleukin-12 during its normal immune response. Interleukin-12 then creates many other immune compounds specific to a particular microbe. Researchers think this flurry of activity may activate any dormant self-reactive cells near the infection. (If the self-reactive cell is for platelets, you get ITP)


Free Radical Damage (Oxidative Stress)

In this theory, the DNA in our cells can be altered by reactive substances in our bodies. When the changed DNA is a part of the immune control function, it can result in a specific autoimmune disease.

Free radicals are particles with an unstable molecular structure that act as scavengers in the body and rob electrons from other molecules.  Their production is hastened by stress, pollution, fertilizers, pesticides, prescription drugs, alcohol, electromagnetic radiation, etc.

Our bodies have built-in methods to control free radicals and change them into neutral substances. These detoxification mechanisms require specific enzymes to make them function well.  If our bodies do not have the vitamins and minerals to make up the enzymes, or if the detoxification mechanism is damaged, the result is a surplus of free radicals and other toxic substances.

The excess free radicals and other noxious byproducts of a failed detox process roam our bodies and attack our weakest links. Depending on the DNA attacked, the electron grabbing can cause an autoimmune disease, including ITP.


Immune System Defects

Both developing and mature T-cells and B-cells (types of white blood cells) have been implicated in the development of ITP. 

The immune system has a way of determining the difference between foreign invaders and normal tissues.  It is a complicated process with various checkpoints.  When one or more of these checkpoints is faulty, antibodies can target important tissues like platelets.

T-regulatory cells (a type of white blood cell) suppress the immune response of other cells.  They keep the immune system in check by halting the immune reaction after clearing a virus or bacteria and by preventing the immune system from over-reacting and attacking normal cells, like platelets. In a study of mice with ITP, researchers found that the T-regulatory cells were retained in the thymus instead of being released into the blood where they could do their job of balancing the immune system.

People with ITP also have fewer B-regulatory cells.  These cells are important in regulating the T-regulatory cells and also play a role in deciding which cells are normal and which are not and need to be eliminated.


Intestinal Changes

Our bodies contain about 100 trillion microbes, most of them bacteria, and most of them living in the digestive tract. These microbes play a role in our adaptive immune system, the part of the immune system that disables harmful viruses and bacteria. When the beneficial bacteria living in the gut are modified by diet, antibiotics, or invading pathogens, the immune system can shift and particles can escape from the digestive tract. These disturbances of the intestinal immune system can lead to various intestinal diseases and have been increasingly linked to immune-mediated diseases outside of the intestine such as rheumatoid arthritis, multiple sclerosis, and other autoimmune diseases.


Other Causes

People diagnosed with ITP sometimes have other diseases that contribute to their low platelets.   See the ‘Other Platelet Disorders’ page for a list.

Some cases of ITP can be drug-induced or the result of eating particular foods.  See the ‘Warnings’ page for more information on these causes.


References

Bacteria and Virus Byproducts

Aster R. “Molecular mimicry and immune thrombocytopenia,” Blood. 23 April 2009, v. 113, no. 17, p. 3887 http://bloodjournal.hematologylibrary.org/content/113/17/3887.full

Blakeslee S. "Virus’s Similarity to Body’s Proteins May Explain Autoimmune Diseases.” New York Times.  December 31, 1996. http://www.nytimes.com/1996/12/31/science/virus-s-similarity-to-body-s-proteins-may-explain-autoimmune-diseases.html

Takahashi T et al. “Helicobacter pylori and chronic ITP: the discrepancy in the clinical responses to eradication therapy might be due to differences in the bacterial strains.” Blood 2004 104:594. http://bloodjournal.hematologylibrary.org/content/104/2/594.full

Travis J. Microbial Trigger for Autoimmunity? Science News. June 21, 1997. http://www.sciencenews.org/pages/sn_arc97/6_21_97/fob1.htm

Zhang W et al. “Role of molecular mimicry of Hepatitis C virus protein with platelet GPIIIa in Hepatitis C-related immunologic thrombocytopenia” Blood 23 April 2009, Vol. 113, no. 17, pp. 4086-4093. http://www.ncbi.nlm.nih.gov/pubmed/19023115

Free Radical Damage

Imbach P. “Oxidative stress may cause ITP.” Blood. 2011 Apr 28;117(17):4405-6. http://bloodjournal.hematologylibrary.org/content/117/17/4405.long

Rogers, Sherry A, M.D., Tired or Toxic? A Blueprint for Health. Syracuse, NY: Prestige Publishing, 1990.

Sharma, Hari, M.D. Freedom from Disease, Toronto, Ontario:Veda Publishing, 1993.

Immune System Defects

Aslam R et al. "Thymic retention of CD4+CD25+FoxP3+ T regulatory cells is associated with their peripheral deficiency and thrombocytopenia in a murine model of immune thrombocytopenia (ITP)." Blood. 2012 Jul 3.
http://www.ncbi.nlm.nih.gov/pubmed/22760780

Fogarty PF. “ITP:Tolerance Lost.” Blood. 2011 Dec 8;118(24):6232-4 http://bloodjournal.hematologylibrary.org/content/118/24/6232.long

Semple JW. “Bregging rights in ITP.” Blood. 2012 Oct 18;120(16):3169.  http://bloodjournal.hematologylibrary.org/content/120/16/3169.full

"Research Sheds New Light on Common Bleeding Disorder." Insciences OrganisationPress Release. July 24, 2012.
http://insciences.org/article.php?article_id=10892

Intestinal Changes

Baydoun A et al. “Hematological manifestations of celiac disease.” Scand J Gastroenterol. 2012 Aug 6. http://www.ncbi.nlm.nih.gov/pubmed/22861356

Fasano A. “Leaky gut and autoimmune diseases.” Clin Rev Allergy Immunol. 2012 Feb;42(1):71-8. doi: 10.1007/s12016-011-8291-x.. http://www.ncbi.nlm.nih.gov/pubmed/22109896

Maynard CL et al. "Reciprocal interactions of the intestinal microbiota and immune system." Nature 489, 231–241, 13 September 2012.
http://www.nature.com/nature/journal/v489/n7415/full/nature11551.html  

Visser J et al. “Tight junctions, intestinal permeability, and autoimmunity: celiac disease and type 1 diabetes paradigms.”Ann N Y Acad Sci. 2009 May;1165:195-205. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2886850/

 

Below is a list of questions and suggestions to enhance your healthcare provider selection and communication.  Pick and choose.

Practitioner:

  • How much experience have you had treating patients with ITP?
  • How many ITP patients have you treated? How are they doing?
  • Are you affiliated with any research group or hospital that specializes in non-malignant hematology?
  • What is your treatment philosophy?  Do you generally treat diseases aggressively or do you have a more conservative treatment approach?
  • Do you welcome a patient who researches the disease and treatments?
  • Do you welcome patient input on their care?
  • What is your feeling about complementary or alternative treatments?

Treatments:

  • What are your usual treatment recommendations for ITP?
  • What course of treatment do you suggest and why?
  • How long will I need this treatment?
  • How will the treatment be administered?
  • What are the criteria for discontinuing the treatment?
  • Is this treatment designed to raise my platelet count temporarily or permanently?
  • What will you recommend next if the treatment fails?
  • What are the side effects of the treatment?
  • For which side effects should I contact you?
  • Are there any precautions that can be taken to minimize the side effects?
  • Will I develop other medical problems from this treatment?
  • How will you monitor the treatment progress?
  • What changes should I make to my life as a result of ITP or the treatment?

Communication:

The Agency for Healthcare Quality and Research, a division of the Department of Health and Human Services, published suggestions to help make the most of your trips to the doctor.  See: "Quick Tips - When Talking with Your Doctor."


IMPORTANT!
Clinical trials listed for ITP are a starting point for discussion with a health care professional. Be sure you understand all the implications of the proposed treatment and read the informed consent very carefully before enrolling in a clinical trial.

What are Clinical Trials?

Clinical Trials are controlled patient studies that must be performed before a new drug or treatment is approved by the Food and Drug Administration in the US and similar organizations in other countries.  Clinical trials are also done after a drug or treatment is approved to document the effectiveness of the treatment or to gain approval to use the drug or therapy for a different disease or age group.

There are three main phases to clinical trials, done in sequence.  A Phase I study tests the safety and side effects of the drug.  A Phase II study is initiated to determine the efficacy of the drug, to see if it works as anticipated.  A Phase III study tests the efficacy of drug or treatment and documents the side effects in a large population of volunteers.

Finding a Clinical Trial

The best way to find the latest information on clinical trials is to visit ClinicalTrials.gov.  Pharmaceutical companies and researchers update this site frequently so it contains the most comprehensive and up-to-date clinical trial listings.  It features an easy-to-use search facility and detailed guidance for patients and industry.

ITP is a diagnosis of exclusion. When all other causes of low platelets are considered and ruled out, the diagnosis is ITP.  However, there are many possible causes of low platelets and more are being discovered each year. Therefore it is possible that the diagnosis of ITP is given when there is an underlying illness, genetic anomaly, environmental trigger or some other reason for low platelets. A misdiagnosis can prompt an incorrect or potentially harmful treatment. See the "Other Platelet Disorders" page for more information.

Help your doctor determine the correct diagnosis. Here is a list of 25 items to mention to your doctor if you or your child experience an episode of low platelets: (“You” or “your” below refers to the person with the low platelet count.)

1. Your platelet count history

2. If you’ve ingested some of the following foods prior to the drop in platelets:

  • wood ear mushrooms
  • quinine (tonic) water
  • bitter melon (dark green melon found in Asian grocery stores)


3. If you took any new prescription or non-prescription medications prior to the drop in platelets

4. If you had any vaccinations or shots in the month prior to the drop in platelets

5. If you took any new supplements, vitamins or herbs prior to the drop in platelets

6. If you were exposed to pesticides, herbicides or other chemicals

7. If you have been diagnosed with lymphoma, lupus, hepatitis C or HIV

8. If you have recurrent stomachaches or an ulcer

9. If you had a fever or felt sick prior to the drop in platelets or are currently not feeling well

10. If you were bitten by an insect prior to the drop in platelets

11. If you were scratched or bitten by an animal or had contact with a new animal prior to the drop in platelets

12. If you had poison ivy or other skin irritation

13. If you recently traveled to another country

14. If others in your family have an autoimmune disease such as lupus, MS, rheumatoid arthritis or thyroid disease

15. If others in your family or ancestors have a bleeding disorder or bruise easily

16. If you’ve always bruised easily

17. If you have a long history of getting more colds, flu or other infections than your friends

18. If you have a hearing problem

19. If you experienced swelling or aching in your joints, sun sensitivity rashes, hair loss or the feeling of numbness or “pins and needles” in your extremities

20. If you have a history of problems with your thyroid gland

21. If you have recently been under a lot of stress

22. If you were recently hospitalized or treated for another condition

23. If you changed your diet or started a new exercise program

24. If you drink more than five alcoholic beverages per week

25. If your low platelets seem to go in monthly or periodic cycles

 

Platelets are very sensitive and can react to many substances, interfering with their ability to clot or triggering their removal from circulation.  Be sure to tell your doctor if your platelets drop or extra bleeding coincided with any new food, drugs, herbs, supplements, or environmental exposure.  “Several hundred drugs, toxins and herbs have been reported to cause blood abnormalities, and drugs account for 20 - 40% of all instances of cytopenias”1

This page contains some of the most well-known causes of substance-induced thrombocytopenia and associated bleeding. If you suspect that something you are taking, eating, or breathing might be the cause of your low platelets or excessive bleeding and you don’t see the link on this page, try searching the Internet using the terms “substance platelets" or "substance thrombocytopenia" where substance is the suspected item. While there is no guarantee, it is possible that removing or discontinuing the offending substance can have a positive effect on your platelet count.  It is important to communicate with your doctor/healthcare provider as you consider or make changes. 

Drug-induced Thrombocytopenia

When drugs are the cause of low platelets, the disease is called drug-induced thrombocytopenia (DITP).  In some cases, as in chemotherapy drugs, the drop in platelet count is due to changes in the bone marrow.  In other cases antibodies can develop to both the drug and platelets at the same time, causing the platelets to drop.  Sometimes drugs cause a combination of both bone marrow and immune problems.42

DITP is rare, can occur with any medication, and is no more likely in patients with ITP than in others, as far as we know.  However, sometimes patients are misdiagnosed with ITP when a substance they ingested caused their low platelets.  We have also heard from patients who have been diagnosed with ITP and a new drug prompted their platelets to drop further.

In the case of DITP caused by an immune reaction, platelets usually drop within one to two weeks after taking the problem drug.  However, low platelets can occur almost immediately after taking some drugs that interfere with the production of blood clots.  If the drug responsible for low platelets is stopped, platelets may begin to recover in one or two days, but the antibodies to the drug can linger in the blood stream for a very long time and cause future problems.2,42  Often the reaction to the drug is specific and a similar compound can be substituted without ill effect.42 If the suspected drug is stopped and the platelets recover, other drugs are introduced without a problem, other causes of thrombocytopenia are excluded, and the drug is introduced again and the platelets drop, there is a definitive diagnosis of DITP.  If only the first criteria is met, DITP is a possible cause of thrombocytopenia. If all but the last criteria are met, DITP is the probable cause.2

Some drugs have been reported to cause more instances of DITP than others.  Sulfa drugs, vancomycin, penicillin, rifampin, ceftriaxone, trimethoprim/sulfamethoxazole and linezolid (antibiotics), gold salts, valproate (for epilepsy), amrinone (for heart problems), biophosphates (ex. Fosamax), quinidine (for abnormal heart rhythms), carbamazepine (controls seizures), mirtazapine (anti-depressant), oxaliplatin and suramin (chemotherapies), the glycoprotein IIbIIIa inhibitors abciximab, tirofiban and eptifibatide, heparin (anti-clotting agents).and quinine (see below) are particular problems. Be sure to tell your doctor if you are taking any herbal remedies or common non-prescription drugs such as acetaminophen (ex. Tylenol) or ibuprofen (ex: Advil, Motrin) as these can also cause DITP.42,45 There should be a compelling reason for taking any medication and medical attention is needed for any side effect, including bruising/bleeding.

Dr. James George and colleagues at the University of Oklahoma track published reports of drugs that cause low platelets and update a summary list every two years.2 Unfortunately, many instances of DITP are not published, so there is no comprehensive compilation of problem drugs. Visit Dr. George's web site to view his list.

The Blood Center of Southeastern Wisconsin has a test for drug-associated antibodies that can help confirm a diagnosis of DITP.

Quinine: a special case

Quinine is found in some drugs as well as in tonic water, bitter lemon, and bitter melons.  Some people whose low platelets were due to drinking or eating these things have been misdiagnosed as having ITP.

In a study of 343 patients, 28 (8%) were found to have drug-induced thrombocytopenia and 13 of these cases were caused by quinine.  Three of these people had an unnecessary splenectomy.2

Herbs, Food, and Supplements

Some food, herbs, and supplements can reduce the number of platelets for various reasons.  This list includes those substances that have been documented in journal or other articles.  It is not known whether there are few items in this category or if they are underreported. If your platelets drop after taking something new, please notify your doctor.

alcohol3,44 (also called ethanol-induced thrombocytopenia)
aspartame (NutraSweet)5
cow’s milk*6
cranberry Juice*6
erucic acid (in Lorenzo's oil, some rapeseed and mustard oil)46
jui [a Chinese medicinal herbal tea]*7
L-tryptophan*8
lupinus termis bean (cultivated in Egypt, a food protein supplement that contains quinolizidine alkaloids)6
niacin (liver damage due to long exposure) 9
tahini (pulped sesame seeds)*6

*allergic or cross-reaction to platelets in those with sensitivities to that substance, similar to drug-induced thrombocytopenia

Environmental Hazards

Exposure to  toxins and household chemicals can cause a drop in platelets in some people.  Below is a list of toxins that have been documented to cause low platelets. You can find more information about environmental medicine and minimizing toxic exposure on Dr. Lisa Nagy's Web site. Check the NIH toxmap for toxic locations near you or local environmental sites such as the Environmental Health Watch

Aromatic hydrocarbons

polyurethane10
toluene methylbenzene (Anisen or Toluol)
(smells like paint thinner, used in the many industrial processes including the production of gasoline and Coca-cola.)11
wood preservatives and solvents12

Insecticides, chlorinated hydrocarbons, and organic phosphorus compounds41

Mycotoxins (toxins that can be produced by molds, yeast, and mushrooms)

mold (can be in the air, on food, or in cardboard)13
P. sorghina (mold on grains)14
trichothecenes (a family of micotoxins)15

Pesticides

Various pesticides increase oxidative stress (implicated in ITP) and can promote platelet destruction in the spleen according to experiments in fish.43

Research and Contacts

Physicians specializing in enviromental medicine may be able to help.  You can find them through the American Academy of Environmental Medicine.  The impact of the environment on autoimmune disease is getting more attention at the National Institute of Environmental Health Science and the press.  Many environmental medicine practitioners recommend using products that are environmental friendly and non-toxic.

(PDSA thanks Dr. Lisa Nagy for help with the environmental hazard list.)

Food and Supplements that Interfere with Platelet Function

This list contains food and supplements that can change the way platelets work and make it more difficult for your blood to clot.  They do not reduce the platelet count unless noted.  A small quantity of these substances will probably be safe and not cause a problem. 

There are many drugs such as Plavix and Coumadin that are designed to interfere with platelet function as well as other drugs such as aspirin that reduce platelet function as a side effect of their other uses.  The food and supplements listed can amplify the effect of these medications. See the results of the  NIH Conference on Dietary Supplements, Coagulation, and Antithrombotic Therapies held January 13-14, 2005, for more information and an extensive bibliography.

Many of the listed substances are also antioxidants or have other properties that promote healing.  A balance is important.  We are publishing this list so you are aware that everyday or easily-available substances can have an effect on platelets, although their anti-clotting action is much weaker than pharmaceuticals. 

If you have a reasonably high platelet count and few bleeding symptoms, many items on this list will not cause problems unless you ingest large quantities.  Ironically, some patients with ITP have a clotting problem and are also taking blood thinners.  Others may have a clotting problem and not know it.  The propensity to clot and medication status are important factors when considering diet choices.  Please discuss any concerns with your doctor.

alcohol (can also reduce the number of platelets)44
aspartame (NutraSweet, can also reduce the number of platelets)16
beer (including non-alcoholic beer)17,18
blueberries19
chocolate (dark)20
coffee21
feverfew22
garlic23
onions24
gingko biloba25
ginger26
ginseng27
green tea28
guarana (a dietary supplement)29
kiwi fruit30
omega 3 fatty acids (hemp seed, fish oil)31, 32
pycnogenol (pine bark extract)33
quercetin, rutin, and related bioflavonoids34, 35
red/purple grape products (grape juice, red wine, raisins, grape seeds)36
red wine37
tomatoes38
vitamin E39
wood ear or cloud ear mushroom (Auricularia auricula-judae, used in Chinese cuisine)40

References

1. Andres E et al. “Recognition and management of drug-induced cytopenias: the example of idiosyncratic drug-induced thrombocytopenia.” Expert Opin Drug Saf. 2009 Mar;8(2):183-90.http://www.ncbi.nlm.nih.gov/pubmed/19309246
2. George JN, Aster RH, “Drug-induced thrombocytopenia:pathogenesis, evaluation, and management” 2009 American Society of Hematology Education Program Book. 153-8.
3. Latvala J et al. “Excess alcohol consumption is common in patients with cytopenia: studies in blood and bone marrow.” Clin Exp Res. 2004 Apr;28(4):619-24. http://www.ncbi.nlm.nih.gov/pubmed/15100613
5. Roberts HJ.."Aspartame-induced thrombocytopenia." South Med J. 2007 May;100(5):543 http://www.ncbi.nlm.nih.gov/pubmed/17534100
6. Royer DJ et al, “Thrombocytopenia as an adverse effect of complementary and alternative medicines, herbal remedies, supplements, foods, and beverages.” Eur J Haematol.  2010. .http://www.ncbi.nlm.nih.gov/pubmed/20059530
7. Ohmori T et al, “Acute thrombocytopenia induced by jui, a traditional herbal medicine.” J Thromb Haemost. 2004 Aug;2(8):1479-80. http://www.ncbi.nlm.nih.gov/pubmed/15304064
8. Morgan JM et al. “Scleroderma and autoimmune thrombocytopenia associated with ingestion of L-tryptophan.” Br J Dermatol.  1993 May;128(5):581-3.http://www.ncbi.nlm.nih.gov/pubmed/8504054
9. Reimund E et al. “Niacin-induced hepatitis and thrombocytopenia after 10 years of niacin use.” J Clin Gastroenterol. 1994 Apr;18(3):270-1. http://www.ncbi.nlm.nih.gov/pubmed/8034946
10. Michelson AD. Am J Hematol. 1991 Oct;38(2):145-6.”Thrombocytopenia associated with environmental exposure to polyurethane.” http://www.ncbi.nlm.nih.gov/pubmed/1951307
11. Jennings GH et al, “Thrombocytopenic purpura in toluene di-isocyanate workers.” Lancet. 1963 Feb 23;1(7278):406-8.http://www.ncbi.nlm.nih.gov/pubmed/14029047
12. Hay A et al. “Wood preservatives, solvents, and thrombocytopenic purpura.” Lancet. 1991 Sep 21;338(8769):766.http://www.ncbi.nlm.nih.gov/pubmed/1716341
13. Gray MR et al. “Mixed mold mycotoxicosis: immunological changes in humans following exposure in water-damaged buildings.” Arch Environ Health. 2003 Jul;58(7):410-20.http://www.ncbi.nlm.nih.gov/pubmed/15143854
14. Rabie CJ et al. “Onyalai--the possible involvement of a mycotoxin produced by Phoma sorghina in the aetiology.” S Afr Med J. 1975 Sep 20;49(40):1647-50. http://www.ncbi.nlm.nih.gov/pubmed/1080886
15. Parent-Massin D. “Haematotoxicity of trichothecenes.” Toxicol Lett. 2004 Oct 10;153(1):75-81. http://www.ncbi.nlm.nih.gov/pubmed/15342083
16. Pretorius E et al. “Ultrastructural changes to rabbit fibrin and platelets due to aspartame.“ Ultrastruct Pathol. 2007 Mar-Apr;31(2):77-83. http://www.ncbi.nlm.nih.gov/pubmed/17613990
17. Bassus S et al. “Effect of Dealcoholized Beer (Bitburger Drive®) Consumption on Hemostasis in Humans.” Alcoholism: Clinical and Experimental Research Volume 28 Issue 5, Pages 786 – 791 http://www3.interscience.wiley.com/journal/118770401/abstract
18. Mann LB et al. “Effects of ethanol and other constituents of alcoholic beverages on coronary heart disease: a review.” Pathophysiology.  2004 Apr;10(2):105-12. http://www.ncbi.nlm.nih.gov/pubmed/15006416
19. Mazza GJ. “Anthocyanins and heart health.” Ann Ist Super Sanita. 2007;43(4):369-74. http://www.ncbi.nlm.nih.gov/pubmed/18209270
20. Innes AJ et al. “Dark chocolate inhibits platelet aggregation in healthy volunteers.” Platelets. 2003 Aug;14(5):325-7. http://www.ncbi.nlm.nih.gov/pubmed/12944249
21. Natella F et al. “Effect of coffee drinking on platelets: inhibition of aggregation and phenols incorporation.” Br J Nutr. 2008 Dec;100(6):1276-82. http://www.ncbi.nlm.nih.gov/pubmed/18439332
22. Heptinstall S et al. “Parthenolide content and bioactivity of feverfew (Tanacetum parthenium (L..)” J Pharm Pharmacol. 1992 May;44(5):391-5.  http://www.ncbi.nlm.nih.gov/pubmed/1359053
23. Ali M et al. “Antithrombotic activity of garlic: its inhibition of the synthesis of thromboxane-B2 during infusion of arachidonic acid and collagen in rabbits.” Prostaglandins Leukot Essent Fatty Acids. 1990 Oct;41(2):95-9.http://www.ncbi.nlm.nih.gov/pubmed/2274570
24. Osmont KS et al. “Temporal aspects of onion-induced antiplatelet activity.” Plant Foods Hum Nutr. 2003 Winter;58(1):27-40. http://www.ncbi.nlm.nih.gov/pubmed/12859011
25. Dutta-Roy AK et al. “Inhibitory effect of Ginkgo biloba extract on human platelet aggregation.” Platelets. 1999;10(5):298-305. http://www.ncbi.nlm.nih.gov/pubmed/16801106
26. Nurtjahja-Tjendraputra E et al. “Effective anti-platelet and COX-1 enzyme inhibitors from pungent constituents of ginger.” Thromb Res. 2003;111(4-5):259-65.http://www.ncbi.nlm.nih.gov/pubmed/14693173
27. Lau AJ et al. “Antiplatelet and anticoagulant effects of Panax notoginseng: comparison of raw and steamed Panax notoginseng with Panax ginseng and Panax quinquefolium.” J Ethnopharmacol. 2009 Sep 25;125(3):380-6.http://www.ncbi.nlm.nih.gov/pubmed/19665534
28. Babu PV et al. “Green tea catechins and cardiovascular health: an update.” Curr Med Chem. 2008;15(18):1840-50. http://www.ncbi.nlm.nih.gov/pubmed/18691042
29. Braz J et al. “A novel property of an aqueous guaraná extract (Paullinia cupana): inhibition of platelet aggregation in vitro and in vivo.” Med Biol Res. 1988;21(3):535-8.http://www.ncbi.nlm.nih.gov/pubmed/3228635
30. Duttaroy AK, et al. “Effects of kiwi fruit consumption on platelet aggregation and plasma lipids in healthy human volunteers “ Platelets. 2004 Aug;15(5):287-92. http://www.ncbi.nlm.nih.gov/pubmed/15370099
31. Rodriguez-Leyva D et al.  “The cardiac and haemostatic effects of dietary hempseed.” Nutr Metab (Lond). 2010 Apr 21;7(1):32.http://www.ncbi.nlm.nih.gov/pubmed/20409317
32. Phang M et al. “Inhibition of platelet aggregation by omega-3 polyunsaturated fatty acids is gender specific-Redefining platelet response to fish oils.” Prostaglandins Leukot Essent Fatty Acids. 2009 Jul;81(1):35-40. http://www.ncbi.nlm.nih.gov/pubmed/19481915
33. Araghi-Niknam M et al. “Pine bark extract reduces platelet aggregation.” Integr Med. 2000 Mar 21;2(2):73-77. http://www.ncbi.nlm.nih.gov/pubmed/10882879
34. Hubbard GP et al. “Ingestion of quercetin inhibits platelet aggregation and essential components of the collagen-stimulated platelet activation pathway in humans.” J Thromb Haemost. 2004 Dec;2(12):2138-45.http://www.ncbi.nlm.nih.gov/pubmed/15613018
35. Navarro-Núñez L et al. “Differential effects of quercetin, apigenin and genistein on signalling pathways of protease-activated receptors PAR(1) and PAR(4) in platelets.” Br J Pharmacol.  2009 Nov;158(6):1548-56. http://www.ncbi.nlm.nih.gov/pubmed/19814731
36. Vitseva O. “Grape seed and skin extracts inhibit platelet function and release of reactive oxygen intermediates.” J Cardiovasc Pharmacol. 2005 Oct;46(4):445-51. http://www.ncbi.nlm.nih.gov/pubmed/16160595
37. Wu JM et al. “Mechanism of cardioprotection by resveratrol, a phenolic antioxidant present in red wine (Review).” Int J Mol Med. 2001 Jul;8(1):3-17. http://www.ncbi.nlm.nih.gov/pubmed/11408943
38. O'Kennedy N et al. “Effects of tomato extract on platelet function: a double-blinded crossover study in healthy humans." Am J Clin Nutr. 2006 Sep;84(3):561-9. http://www.ncbi.nlm.nih.gov/pubmed/16960170
39. Zingg JM et al. “Non-antioxidant activities of vitamin E.” Curr Med Chem. 2004 May;11(9):1113-33. http://www.ncbi.nlm.nih.gov/pubmed/15134510
40. Tom Volk's Fungus http://botit.botany.wisc.edu/toms_fungi/apr2004.html
41. Mastromatt.eo E. “Hematological Disorders Following Exposure to Insecticides.”Can Med Assoc J. 1964 May 16; 90(20): 1166–1168.  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1922786
42. Aster RH, "Drug-induced immune thrombocytopenia" N Engl J Med. 2007 Aug 9;357(6):580-7. http://www.ncbi.nlm.nih.gov/pubmed/17687133
43. Slaninova A et al. "A review: oxidative stress in fish induced by pesticides." Neuro Endocrinol Lett. 2009;30 Suppl 1:2-12.
http://www.ncbi.nlm.nih.gov/pubmed/20027135
44. Ballard HS, "The hematological complications of alcoholism." Alcohol Health and Research World.1997; 21(1):42-52. http://pubs.niaaa.nih.gov/publications/arh21-1/42.pdf
45. Arnold DM et al. "A systematic evaluation of laboratory testing for drug-induced immune thrombocytopenia." J Thromb Haemost. 2012 Nov 3.
http://www.ncbi.nlm.nih.gov/pubmed/23121994
46. Kickler TS et al. “Effect of erucic acid on platelets in patients with adrenoleukodystrophy.” Biochem Mol Med. 1996 Apr;57(2):125-33. http://www.ncbi.nlm.nih.gov/pubmed/8733890

Periodically, PDSA seeks opinions on various aspects of treating and living with ITP. Below are the results from some recent surveys.

What You Said: “The Impact of ITP” Questionnaire Findings

gsk2Thank you to those who shared your ITP experiences through our online survey, and thanks to GlaxoSmithKline for funding and developing the questionnaire.

Download PDF


Non-Traditional Treatments of ITP

In conjunction with James Bussel, MD of the Weill Medical Center of Cornell University, 916 participants answered questions concerning their experience with traditional and non-traditional (complementary) treatments as well as commented on physician communication.

View Results


Health-Related Quality Of Life

A total of 1,002 ITP patients and 1,031 age and gender-matched controls answered questions from three standard quality-of-life questionnaires plus additional questions in a survey funded by Amgen. Selected results were published in three journal articles. Below are links to the abstracts. Contact PDSA for copies of the articles.

  • “Impact of ITP on physician visits and workplace productivity.”

    View Abstract


  • “Health-related quality of life of immune thrombocytopenic purpura patients: results from a web-based survey.”

    View Abstract


  • “Impact of corticosteroid-related symptoms in patients with immune thrombocytopenic purpura: results of a survey of 985 patients.”

    View Abstract



It was once thought that ITP was a simple disease….antibody coated platelets are removed by the spleen, leaving a reduced platelet count.  However, as researchers study each step, from platelet production to platelet elimination, they continue to find subtleties to this process that have made a difference in how the disease is viewed and treated.  

 

Platelet Production

Platelets are released from cells in the bone marrow called megakaryocytes.  Bits of the megakaryocyte bud and elongate, creating a long chain of proplatelets.  Next, the proplatelet chain splits apart releasing the platelets singly or in groups.  These released platelets are still considered cells, although they lack a nucleus.  

Normal production of platelets is 35,000 per microliter per day and may increase much beyond that in ITP patients.  However, in people with ITP, antibodies may interfere with megakaryocyte function and reduce the ability of the megakaryocyte to increase its rate of platelet production.  

Thrombopoietin (TPO), a protein made in the liver, travels through the bloodstream and signals the bone marrow to make more platelets.  In other diseases of low platelets the amount of TPO in the blood rises; for many reasons, the TPO level is usually not increased in people with ITP.   See the treatment information on how increasing TPO can help increase the platelet count.

 

Platelet Function

The foremost job of platelets is to form clots and stop bleeding.  Because they have fewer platelets, people with ITP are more prone to prolonged bleeding.  Platelets are also responsible for assuring the integrity of the blood vessel walls. They plug up small holes and form clots when vessel walls are injured.  Without sufficient platelets to maintain the blood vessel walls, people develop spontaneous bruises or pinpoint hemorrhages called petechiae.

Platelets transport serotonin, a mood elevating neurotransmitter. Platelets also carry serotonin’s 'parent' or precursory chemical, L-tryptophan1. These substances are involved in such processes as sleep/wake cycles, biological rhythms, appetite, mood regulation, etc.

Platelets may also play a role in the immune system. They can promote inflammation, may help regulate your innate immune system 2 (the one you were born with), and can interact directly with microorganisms such as bacteria. Because they are the first to reach the scene of a wound, they are well-positioned to direct the body’s response to bacterial infections. Platelets can interact with bacteria directly or through various proteins circulating in the blood. 3

Researchers continue to learn more about platelets.  So far they know that platelets contain more than 5,000 different proteins, enter into more than 13,500 different reactions, and contain nearly 1,000 drug targets.5

 

Platelet Antibodies

Antibodies may attach to platelets because parts of the platelet may look like a virus or bacteria the body is fighting, because of a defect in the immune system, or for other reasons.

In most people with ITP, antibodies attach to their platelets on a surface protein called glycoprotein IIB/IIIA.  However, the antibodies can attach to other parts of their platelets as well.  While researchers have tried very hard to create a laboratory test to diagnose ITP by measuring the anti-platelet antibodies, this has not been successful since some people with ITP have no detectable antibodies and some people with a normal platelet count have anti-platelet antibodies according to these diagnostic tests.

 

Platelet Lifespan

For people with ITP, platelets stay in the blood stream from a few days to a few hours depending on the severity of the disease, much shorter than the normal lifespan of eight to ten days. The antibody-coated platelets are engulfed and eliminated by macrophages (cells designed to remove debris) in the spleen and sometimes, the liver. Platelets can also be removed by T-cells 4,6(a type of white blood cell).

 Watch a video of the platelet destruction process:

 

 References:

1. Gronier B et al. “Evidence for a defective platelet L-tryptophan transport in depressed patients.” Int Clin Psychopharmacol. 1993 Summer;8(2):87-93. http://www.ncbi.nlm.nih.gov/pubmed/8345162

2. Semple JW et al. “Platelets and innate immunity.” Cell Mol Life Sci. 2010 Feb;67 (4):499-511.
http://www.ncbi.nlm.nih.gov/pubmed/20016997

3. Cox D et al. “Platelets and the innate immune system: Mechanisms of bacterial-induced platelet activation.” J Thromb Haemost. 2011 Mar 21. doi: 10.1111/j.1538-7836.2011.04264.x.
http://www.ncbi.nlm.nih.gov/pubmed/21435167

4. Catani L et al.  “Dendritic cells of immune thrombocytopenic purpura (ITP) show increased capacity to present apoptotic platelets to T lymphocytes.” Experimental Hematology. Vol.34, Issue 7, July 2006, Pages 879-887.(http://www.sciencedirect.com/science/article/pii/S0301472X06001962)

5. The Platelet Web http://plateletweb.bioapps.biozentrum.uni-wuerzburg.de/plateletweb.php

6. Sarpatwari A et al. “Autologous 111 In-labelled platelet sequestration studies in patients with primary immune thrombocytopenia (ITP) prior to splenectomy: a report from the United Kingdom ITP Registry.” Br J Haematol. 2010 Dec;151(5):477-87. http://www.ncbi.nlm.nih.gov/pubmed/20950403

If you have ITP and you are tired, depressed, have muscle aches, mood swings, dread the next platelet count, or are just plain scared, you are not alone.  There have been several studies that confirm people with ITP often struggle with their disease and treatments. 4,5,6  The good news is that there are things you can do to help minimize these problems and improve your quality of life.


Find Help in FREE PDSA Publications

Coping with ITP (26 page booklet)
Living with ITP - Answers to Common Questions (38 page booklet)
Diet and Lifestyle Suggestions
Emergency Card


Meet Others

• 'Talk’ to others on the PDSA Discussion Group.
Join a Local Support Group.
Attend the Annual Conference


Improve Fatigue

Many people with ITP and other autoimmune diseases feel tired much of the time.1,2,3  There are many things you can do to improve your energy, such as diet changes, meditation, and yoga, that may also improve the platelet count.  See the Complementary Treatment Section of the Web site for ideas.


Get Caregiver Support

Find information at The National Family Caregivers Association, Family Caregiving 101, and Lotsa Helping Hands.


Wear Medical Alert Jewelry

Be prepared for an emergency. Stay safe and in style to alert paramedics and others of your medical condition.
www.medicalert.com or call 1-800-432-5378.
www.laurenshope.com
www.creativemedicalid.com/home
www.hopepaige.com
www.n-styleid.com/medical-id-alert-bracelets.html

These links are provided as a public service and does not imply endorsement or support of any product, program or organization. The information on this Web site is provided for educational purposes only. Consult a health care provider concerning your particular condition.


Deal with Prednisone Symptoms

Prednisone can have damaging effects and causes many problems for people with ITP.5  However, there are things you can do to lesson the problems of weight gain, muscle loss, bone loss, mood swings, etc. associated with prednisone use. "Coping with Prednisone" is a book that can guide you to a healthier life while taking this drug or after you have stopped.  It is available in The Platelet Store.


Stop Bleeding

Some doctors recommend Amicar (aminocaproic acid) or tranexamic acid to help slow mucosal (mucus membrane) bleeding, especially helpful for dental visits. The pill form can be carried with you and used in an emergency in case you start bleeding.  Ask your doctor whether this type of product would be good for you or your child.  Salt pork or bacon has also been used to stop nosebleeds.6


Remove Blood from Clothes

Just douse the spots with hydrogen peroxide. It makes the blood disappear and doesn't seem to harm the fabric.


Laughter is the Best Medicine

Comedian Rocky LaPorte kept us in stitches at the PDSA 10th anniversary party in Chicago.
Now hear excerpts from his new CD or order it online.
http://www.rockylaporte.com/
http://cdbaby.com:80/cd/rockylaporte


References

1. "How Inflammatory Disease Cause Fatigue." Medical News Today. 19 Feb 2009. http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=139443
2. Newton JL et al. “Fatigue in adult patients with primary immune thrombocytopenia.”  Eur J Haematol. 2011 May;86(5):420-9.  http://www.ncbi.nlm.nih.gov/pubmed/21323737
3. Blatt J et al. “Fatigue as marker of thrombocytopenia in childhood idiopathic thrombocytopenic purpura.” Pediatr Hematol Oncol. 2010 Feb;27(1):65-7. http://www.ncbi.nlm.nih.gov/pubmed/20121557
4.Snyder CF et al.  “Health-related quality of life of immune thrombocytopenic purpura patients: results from a web-based survey. “ Curr Med Res Opin. 2008 Oct;24(10):2767-76. http://www.ncbi.nlm.nih.gov/pubmed/18715526
5. Berti D et al. “Impact of corticosteroid-related symptoms in patients with immune thrombocytopenic purpura: results of a survey of 985 patients.”  Clin Ther. 2008 Aug;30(8):1540-52. http://www.ncbi.nlm.nih.gov/pubmed/18803995
6. Humphreys I, et al. “Nasal packing with strips of cured pork as treatment for uncontrollable epistaxis in a patient with Glanzmann thrombasthenia.” Ann Otol Rhinol Laryngol. 2011 Nov;120(11):732-6.  http://www.ncbi.nlm.nih.gov/pubmed/22224315





Many women with low platelets are concerned about having a family. A low platelet count does not prevent a woman from becoming pregnant or delivering a fine, healthy baby. However, the situation does require special attention and close coordination between the woman’s hematologist, obstetrician, and pediatrician.

Sometimes a low platelet count is discovered when a woman is pregnant. If that’s the case, it is important to determine if the low platelet count is associated with pregnancy (gestational thrombocytopenia) or due to another cause, such as ITP. The journal article, "How I treat thrombocytopenia in pregnancy" contains information on how to tell if low platelets in pregnancy are due to ITP or some other cause and the best way to treat the condition.


Treatment for ITP during pregnancy

If a woman has ITP and becomes pregnant, her platelet count may drop in the third trimester or she may relapse. However, treatments such as IVIg or prednisone can be given to raise the platelet count for delivery. Some treatments that are used for ITP, particularly those that suppress the immune system (except azathioprine) or stimulate platelet production, are not good options for pregnant women because they could harm the fetus.  The thrombopoietin mimetics (TPO agents) are not recommended during pregnancy because they can cross the placenta. Women should wait up to a year after Rituxan treatments end before becoming pregnant.Some studies link prenatal corticosteroids (ex. prednisone) to mental health problems later in the child's life. 4


Delivery

There is no evidence that a cesarean is safer for the baby in a mother with a low platelet count, so the decision to have a vaginal birth or cesarean should be based on the best method of delivery given the mother’s circumstances.1 Most physicians recommend maintaining a platelet count above 20,000 to 30,000 platelets per microliter throughout pregnancy and above 50,000 near term. A higher count between 80,000 and 100,000 per microliter would be required for an epidural anesthesia 

Only a very small percent of babies born to mothers with ITP have low platelets at birth. Attempting to measure the platelet count of the fetus carries significant risk, so it is not advised. However, it is fine to do a cord blood count after delivery.2


Breastfeeding

Breastfeeding can be safely accomplished following pregnancies complicated by ITP or gestational thrombocytopenia. There is concern among some physicians because anti-platelet antibodies can be passed to the newborn in the colostrum of ITP mothers. However, there is no evidence that children breastfed by ITP mothers are at elevated risk.


See the FREE PDSA publication for more information

ITP and the Female Lifecycle (26 page booklet)


References

1. Letsky EA, Greaves M. “Guidelines on the investigation and management of thrombocytopenia in pregnancy and neonatal alloimmune thrombocytopenia. Maternal and Neonatal Haemostasis Working Party of the Haemostasis and Thrombosis Task Force of the British Society for Haematology.”  Br J Haematol. 1996 Oct;95(1):21-6. http://www.ncbi.nlm.nih.gov/pubmed/8857933

2. Burrows RF, Kelton J. “Pregnancy in patients with idiopathic thrombocytopenic purpura: assessing the risks for the infant at delivery.”  Obstet Gynecol Surv. 1993 Dec;48(12):781-8. http://www.ncbi.nlm.nih.gov/pubmed/8309660

3. Chakravarty EF et al. “Pregnancy outcomes after maternal exposure to rituximab.” Blood. 2011 Feb 3;117(5):1499-506. http://www.ncbi.nlm.nih.gov/pubmed/21098742

4. Khalife N et al. “Prenatal Glucocorticoid Treatment and Later Mental Health in Children and Adolescents.” PLOS ONE. 2013 Nov. 22. http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0081394

 

Do other members of your extended family have low platelets?

Sometimes people are diagnosed with ITP when they have an entirely different disease, inherited or familial thrombocytopenia, low platelets caused by a genetic mutation, not by auto-antibodies.  Getting the right diagnosis is extremely important.  Identifying the correct disease helps to avoid unnecessary treatments, receive the most effective care, and manage the risk of related symptoms.

Some types of inherited thrombocytopenia are easy to spot. The platelets can be almost as large as red blood cells or very small, and are often accompanied by additional physical problems. But other cases are very difficult to diagnose or go undiagnosed because here are no specific tests to identify this group of diseases.  The platelet size may be normal, several genes may be involved, and not everyone who carries the gene mutations has symptoms, including the parents.

 

Here are the major questions to ask:

• Have the platelets always been low?
• Do they look different?
• Is there a history of low platelets or treatment for ITP in the family?
• Does the person have other congenital abnormalities?

If some of these answers are ‘yes’ discuss the possibility of inherited thrombocytopenia with the doctor and keep reading about the subject.


This is an evolving and exciting area of research.  As scientists continue to explore the genetic make-up of people with suspected inherited thrombocytopenia they are finding more mutations and additional disease categories, but many undiagnosed and misdiagnosed cases remain.   Here’s how you can help.

If you or someone you know suspects genetics are a factor in causing low platelets contact Dr. Terry Gernsheimer in Seattle, Washington, Dr. Michele Lambert in Phildadelphia, Pennsylvania, the ITP registry in London, or the MYH9 related diseases registry in Italy.

There are several different genetic problems that are known to result in low platelets and more are being investigated. See the Other Platelet Disorders Page for a list.

(This section is based on Dr. Amy Geddis' presentation at the 2011 ITP Conference)

 

Family Health History Awareness and Collection

Your family health history is an important component of a primary care visit. It is an independent and significant risk factor for many common, chronic conditions as well as rare genetic disorders, and it is often called the most basic genetic test.

Here are some tools to help record and track your family's health history:

"Does It Run In The Family?" toolkit (from Genetic Alliance)

My Family Health Portrait (from the office of the Surgeon General)

 

Other Resources

GenesInLife.org: Genes in Life is a place to learn about all the ways genetics is a part of your life. On the site you will learn how genetics affects you and your family, why you should talk to your healthcare providers about genetics, how to get involved in genetics research, and much more!

ITP in children is often considered a different disease than ITP in adults because children usually recover more easily. However, ITP in adolescents is more like ITP in adults with a greater chance of it lasting a long time.

The most feared complication of ITP is intracranial hemorrhage, a bleed to the brain, like a stroke. Fortunately, this is rare, occurring in less than .5 to 1.0% of the children diagnosed with ITP.

About 4.3 to 5.3 per 100,000 children are diagnosed with ITP each year.1,2  Since children with ITP usually recover, the number of children who have ITP at any one time is about equal to those diagnosed annually.3

Because ITP is a diagnosis of exclusion, it is important to rule out other causes of low platelets and tell the doctor about events that could have triggered the low platelets.

More about Other Platelet Disorders

Treatments

The treatments for ITP in children can vary depending on the child’s platelet count, activity level and bleeding symptoms. Whatever the treatment regimen, it is important for the child to have as normal a life as possible. Because many children recover and the treatments can be difficult, some pediatric hematologists suggest a watchful waiting approach. The 2011 American Society of Hematology guidelines recommend that children be managed with observation alone if they have only mild or no bleeding symptoms, regardless of platelet count.6 New treatments for children are in Clinical Trials.

More about Treatments


Vaccinations

About one in every 25,000 MMR vaccinations will result in a diagnosis of ITP4. Gardasil is associated with the development of ITP.  However the incidence of this side effect is not known.5

For information on informed vaccine decisions, visit the National Vaccine Information Center and the vaccine information from the Centers for Disease Control.

Free Materials

PDSA has many free materials to help you, your family, and your child's teachers understand more about ITP. See the side bar or the free materials page for a list.

 

References

1. Fogarty PF, Segal JB. "The epidemiology of immune thrombocytopenic purpura." Curr Opin Hematol. 2007;14: 515-519. http://www.ncbi.nlm.nih.gov/pubmed/17934361

2. Zeller B, Helgestad J, Hellebostad M, et al. "Immune thrombocytopenic purpura in childhood in Norway: a prospective, population-based registration." Pediatr Hematol Oncol. 2000;17(7):551-558. http://www.ncbi.nlm.nih.gov/pubmed/15981751

3. Segal JB, Powe NR. "Prevalence of immune thrombocytopenia: analyses of administrative data." J Thromb Haemost. 2006;4(11):2377-2383. http://www.ncbi.nlm.nih.gov/pubmed/16869934

4. Black C, Kaye JA, Jick H. "MMR vaccine and idiopathic thrombocytopaenic purpura." Br J Clin Pharmacol. 2003 Jan;55(1):107-11. http://www.ncbi.nlm.nih.gov/pubmed/12534647

5. Gardasil package insert. http://www.merck.com/product/usa/pi_circulars/g/gardasil/gardasil_pi.pdf

6. Neunert C. “The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia.” Blood. April 21, 2011 vol. 117 no. 16 4190-4207. http://bloodjournal.hematologylibrary.org/content/117/16/4190.full

ITP, immune thrombocytopenia (also known as immune or idiopathic thrombocytopenic purpura) is an autoimmune disease. In autoimmune diseases, the body mounts an immune attack toward one or more seemingly normal organ systems. In ITP, platelets are the target. They are marked as foreign by the immune system and eliminated in the spleen, the liver, and by other means. In addition to increased platelet destruction, some people with ITP also have impaired platelet production.

A normal platelet count is between 150,000 and 400,000/microliter of blood.  If someone has a platelet count lower than 100,000/microliter of blood with no other reason for low platelets, that person is considered to have ITP.1 There is no accurate, definitive test to diagnose ITP.

With few platelets, people with ITP often have bleeding symptoms such as spontaneous bruising, petechiae (pe-TEEK-ee-ay), tiny red dots on the skin, or for women, heavy menses. More severe bleeding symptoms include blood blisters on the inside of the mouth, blood in the urine or stool, or bleeding in the brain.

Treatments for the disease vary depending on the platelet count, severity of symptoms, age, lifestyle, personal preferences, and any other associated diseases. Some people may choose to not treat their disease and live with low platelets.

While it may seem like ITP is a simple disease, there are nuances to the diagnosis, differences in the disease between children and adults, and variations in how the disease responds to treatments. The pages in this section provide more details to help you or your loved one manage the disease.

IMPORTANT!
The information on this website is provided for educational purposes only. Consult a health care provider concerning your particular condition.


1. Rodeghiero F, Stasi R, Gernsheimer T, et al. Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood. 2009;113(11):2386-2393.

Most cases of ITP in adults are persistent, lasting more than six months, or chronic, lasting more than a year.1  A very small number of people die from the disease or the treatments and some people recover.

It is difficult to determine how many adults have ITP, so estimates vary. The latest review study reports that the incidence of adult ITP (how many people get diagnosed each year) is 3.3 per 100,000 adults/year.3 The prevalence (how many adults have ITP at any time) is approximately 9.5 cases per 100,000. More women than men have the disease in the 30 to 60 age group. In other age groups, about the same number of men and women are diagnosed with ITP.2

Since ITP is a diagnosis of exclusion, it is very important that all other causes of low platelets are ruled out. There are many low platelet diseases and the treatments differ. An ITP patient can help the doctor eliminate other causes for ITP by mentioning any new medications, frequent consumption of tonic water, exposure to toxins, or events that coincide with the discovery of low platelets.

More about Diagnosis Questions


Treatments

There are various approaches to treating ITP depending on the platelet count, bleeding symptoms, patient preference, age, lifestyle considerations and other health issues. It is important for both the patient and physician to carefully weigh the potential risks along with the potential benefits when making a treatment decision. Treatments should be tailored to the individual, not based on a platelet count.

More Treatments Info


References

1. Rodeghiero F, Stasi R, Gernsheimer T, et al. "Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group." Blood. 2009;113(11):2386-2393. http://www.ncbi.nlm.nih.gov/pubmed/19005182

2. Segal JB, Powe NR. "Prevalence of immune thrombocytopenia: analyses of administrative data." J Thromb Haemost. 2006;4(11):2377-2383 http://www.ncbi.nlm.nih.gov/pubmed/16869934

3. Terrell DR, et al. "The incidence of immune thrombocytopenic purpura in children and adults: A critical review of published reports." Am J Hematol. 2010 Mar;85(3):174-80.http://www.ncbi.nlm.nih.gov/pubmed/20131303