About ITP

Frequently Asked Questions - ITP in Children

Q: What is ITP?

A: ITP (Immune Thrombocytopenic Purpura) is a bleeding disorder caused when the body’s defense (immune) system mounts an attack and destroys healthy blood platelets thinking they are disease-causing agents.

• Immune - the immune system is involved
• Thrombocytopenic – the blood doesn’t have enough platelets
• Purpura – bleeding into the skin or bruisin

Q: Will my child recover?

A: ITP can be either acute (sudden onset, often temporary) or chronic (long lasting). Most children (80-90%) have acute ITP. These children usually recover within a few months whether they receive treatment or not. Recovery is possible even if your child is considered to have chronic ITP.

Q: Why are platelets so important?

A: Platelets are small, sticky, components of the blood formed in the bone marrow (the soft, porous tissue found in the long bones of the body). Their job is to maintain the integrity of the blood vessels and seal small cuts and wounds by forming a blood clot. If the blood doesn’t have enough platelets it is unable to clot successfully. The result is excessive bruising and the tendency for people with ITP to bleed for a long time. It is possible, with a very low platelet count, to have spontaneous bleeding including a cerebral hemorrhage.

Q: Why doesn’t my child have enough platelets?

A: To fight infections, antibodies (immune system proteins) attach to foreign infection-causing agents (bacteria, parasites and viruses) that have invaded the body. The spleen and other organs in the body whose job is to filter and rid the blood of aged or foreign cells, eliminate these antibody-coated cells. In children with ITP, these same antibodies somehow become attached to healthy platelets causing the platelets to be rapidly eliminated. Most children with ITP are still able to make new platelets in normal or increased numbers, but as long as antibodies continue to attach to them, they will continue to be destroyed.

Although ITP is a blood disorder, there is nothing wrong with your child’s red and white blood cells. ITP does not lead to the development of leukemia or cancer.

Q: What is a normal platelet count?

A: The platelet count in a healthy person is between 150,000 – 450,000 platelets per micro liter of blood, although a count of 30,000 – 50,000 is enough to prevent bleeding in all but the most severe injuries or during surgery. The lower the platelet count, the higher the risk of bleeding. Platelet counts lower than 10,000 generally require immediate treatment and should be considered emergencies.

Q: How did my child get ITP?

A: Doctors don’t know what causes ITP, but it often occurs in otherwise healthy children a few days or weeks after a viral infection. It’s thought that for some unknown reason this infection causes the immune system to lose the ability to distinguish between the body’s own cells and those of invaders. There is also some evidence that certain vaccines may trigger ITP, but this occurs in only a small percentage of cases. Why ITP happens in some children and not others who have had the same infection, virus or vaccine is not known.

Q: What are the symptoms of ITP?

A: The first noticeable symptoms of ITP are usually the sudden appearance of excessive bruises and tiny red dots on the skin called petechiae (pe-TEEK-ee-ay). Your child may experience nosebleeds that are hard to stop and/or bleeding gums. Some parents report their child experiences mood swings and/or depression when the platelet count is low.

Q: How is ITP diagnosed?

A: There is no definitive test for ITP. Your doctor will do tests that rule out other causes of low platelets. If no other cause is found, then the diagnosis is often ITP.

Q: I’ve heard my child may have to have a bone marrow test. What does this entail?

A: In some cases a pediatric hematologist (blood specialist) will ask to take a sample of bone marrow from the pelvic bone in your child’s back (bone marrow test). This is performed to ensure the bone marrow is still making platelets and there is nothing wrong with other blood cells in the marrow. However, most doctors agree that bone marrow examinations are unnecessary in children with ITP unless a different diagnosis is suspected.

Q: Is ITP dangerous to my child?

A: It can be. But, the danger is primarily related to your child’s platelet count. For example, a platelet count of less than 50,000 may cause your child to bleed or bruise easily. A platelet count lower than 10,000 will increase the risk of serious bleeding. However, life-threatening bleeding, including intracranial hemorrhage (bleeding in the brain) is rare, and occurs in less than 1 percent of children.

It’s important to note that if your child’s platelet count is very low your child should not be given aspirin or any medicine containing aspirin (acetylsalicylic acid). Nor should your child be given anti-inflammatory medicines such as ibuprofen or naproxen, or any medicine containing glycerol guaiacolate (robutussin), as these medicines can prevent the few platelets your child has from working properly. As a precaution check with your doctor before giving your child any medicine other than acetaminophen (Tylenol).

Q: When is immediate medical attention needed?

A: Contact your doctor immediately if your child hits his head, or has a serious accident. Also, be on the look out for lots of bruises or petechiae, as these indicate your child’s platelet count is low. The doctor will want to be informed if your child has nosebleeds, bleeding gums, blood in the urine or stools, blood in vomit or during coughing, repeated vomiting, or any other unusual behavior or illness.

Q: Is ITP contagious?

A: No. ITP is not contagious.

Q: What are the treatments and their side effects?

A: Because ITP in children generally resolves on its own, your hematologist may not recommend any treatment for your child other than a weekly or biweekly blood test to monitor the platelet level. As soon as the platelet count increases, the interval between blood tests may be lengthened; but your child will still be monitored until the platelet level returns to normal and is stable. If treatment is recommended the following medicines may be used to keep the platelet count within a safe range until your child’s body recovers.

Prednisone. Prednisone is a synthetic medicine (i.e. steroid) similar to cortisone, a natural substance produced in the body’s adrenal glands. It is used in the treatment of ITP because it has been shown to increase the platelet count while it is being taken.

Possible Side Effects. Prednisone is generally only given for a few weeks at a time because it can have serious side effects with long-term use. And even when it is given for a short time many children become more irritable, have stomach upsets, sleep disturbances, increased appetite, weight gain, puffy cheeks, frequent urination, sugar in the urine, loss of bone density, or acne. When the medicine is stopped, these side effects will begin to disappear.

Intravenous Gamma Globulin (IVIG). IVIG is a liquid concentrate of antibodies purified from the plasma (the liquid portion of the blood that doesn’t contain red blood cells) of healthy blood donors. IVIG is believed to work by overwhelming the spleen with antibody so that it cannot recognize the antibody-coated platelets. IVIG treatment will usually result in a rapid (24-48 hours) increase in your child’s platelet count, but any improvement is generally short-lived. Treatment may be repeated until the platelet count improves permanently.

If IVIG is the recommended treatment for your child it will be given directly into a vein in the arm (intravenous infusion) for several hours a day over a period of 1-5 days.

Possible Side Effects. Some children treated with IVIG experience nausea and vomiting, headaches or fever and rarely, aseptic meningitis, abnormal blood clots or kidney failure.

Anti-Rho (D) immune globulin (WinRho®). WinRho® is also a liquid concentrate of antibodies derived from healthy human plasma. However, this medicine is targeted against the Rh factor* on red blood cells. It is thought that WinRho® binds to red blood cells to such an extent that the spleen is fully occupied eliminating red blood cells and does not have much opportunity to remove the antibody-coated platelets. Like IVIG, the response is usually rapid but temporary.

If a hematologist recommends treating your child with WinRho®, it will be given by intravenous infusion. The procedure takes less than a half hour and can be done during an outpatient visit. WinRho® will generally not work in children who are Rh-negative or who have had a splenectomy (removal of the spleen).

* Most people have Rh-positive blood. This means they produce the Rh factor, an inherited protein found on the surface of red blood cells. A small percentage of people lack the Rh factor. They are considered Rh-negative.

Possible Side Effects. Temporary side effects from WinRho® include fever, headache, chills, nausea and vomiting and anemia, and rarely, kidney failure.

Other treatments. Your doctor may suggest other treatments for your child. You can contact our organization or web site (www.pdsa.org) for information about these.

Please note that side effects from all treatments will vary from one child to another. Your child may experience all, some, or no side effects at all.

Q: What about alternative and complimentary treatments?

A: Although few scientific studies have been conducted to assess how effective alternative and complimentary therapies are in the treatment of ITP, some patients report success with herbal therapies, Vitamin C, antioxidants and mind/body interventions. Be sure to your let your child’s doctor know if you are considering alternative and complimentary treatments.

Q: Can my child’s ITP return again?

A: A small number of children with acute ITP who appear to have recovered will have a recurrence of ITP. A recurrence of ITP may indicate that chronic ITP is developing and should be carefully monitored. Consult your doctor for more information.

Q: What if my child doesn’t get better?

A: If your child’s ITP persists beyond 6 months from the time of diagnosis your child will be classified as having chronic ITP. The treatment, as with acute ITP, will focus on minimizing the risk of bleeding. A small percentage of children with chronic ITP, who are over five years of age, and who suffer from persistent bleeding, may be assessed for the risks/benefits of a splenectomy.

Q: Will my child get other illnesses because of ITP?

A: If your child is otherwise healthy she should be no more susceptible to contracting illnesses or viruses than children who do not have ITP. However, if your child is being treated with steroids (prednisone) or another drug that suppresses the immune system or has had a splenectomy your child’s ability to fight infections will be lowered.

Q: If I have more children, will they get ITP?

A: As ITP is not hereditary, it is unlikely to affect other members of your family.

Q: How will my other children feel?

A: Other family members, including children, may feel confused, guilty, angry and jealous.

• Confused – because they don’t understand what’s going on.
• Guilty – because they think something they did may have caused their brother or sister to get ITP.
• Angry and jealous – because everyone’s attention is focused on ITP, and normal family life has been disrupted.

ITP is a family issue and, as such, your other children and family members should be kept as informed as possible about what’s going on—although this can be difficult for young children who may find it hard to understand why the family routine has suddenly changed. Many parents of children with ITP find that encouraging children to express their emotions and setting aside some time alone with each of them at least once a week can help.

Q: What should I tell people?

A: What you tell people about your child’s ITP will primarily depend on their role in your child’s life, and how much your family wants other people to know. Below is a guide that will help you tell other people about ITP.

For acquaintances you may want to say…

"ITP is a blood clotting disorder. She/he bruises and bleeds very easily. But, it’s not contagious."

For teachers, scout leaders, day care staff, and coaches you may want to say...

"ITP puts her at risk of injury. If she bleeds, this is how to stop it, and this is how to reach me. If trauma occurs that causes loss of consciousness, call 911 immediately, then contact me."

If your child is on medication, you may want to add...

"The medicine makes her feel hungry/tired/irritable, but the disorder itself doesn’t make her feel bad."

Please feel free to distribute this booklet among caregivers, friends and family members. The information it contains will not only increase their understanding of ITP, but minimize their fear and anxiety.

Q: What sports and activities can my child participate in?

A: Having ITP shouldn’t stop your child from having fun, but if the platelet count is low certain activities will need to be restricted in order to lower the risk of bleeding. Your child’s doctor will help you assess which sports and activities are safe for your child.

Remember to make sure your child wears the recommended safety equipment such as helmets, kneepads, elbow pads and wrist pads appropriate to the sport or activity.

Q: What will happen when my daughter starts menstruating?

A: Young girls with ITP may experience heavy bleeding and prolonged menstruation with their first or all of their periods. If this becomes a problem, oral contraceptives can be used to decrease the severity of menstruation. In cases where oral contraceptives fail to control bleeding, depo-provera (a form of progesterone that inhibits ovulation) can be given via injection every 3 months or so to completely stop menstruation until the ITP has resolved, or at least been controlled.

Q: Where can I meet other parents of children with ITP?

A: The Platelet Disorder Support Association offers several ways for parents to meet other families of children with ITP. These include a discussion group, a name exchange program, an annual conference, and regional meetings during the year.

Q: What else can I do to help my child?

A: Here are some suggestions.

• Try to find other children with ITP or join a family support group in your area.
• Learn as much about ITP as possible, and be there to listen when your child is not feeling well.
• Keep your child active. Just because they can’t play football doesn’t mean they can’t play tennis.
• Use "maybe" instead of "no" if an activity or outing is uncertain.
• Purchase a medical alert bracelet.
• Maintain academic expectations (if your child is of school age) and continue household responsibilities, because that is life too.
• Concentrate on what they can do, not what they can’t.
• For younger kids, provide soft surfaces for them to play on and choose exciting activities that don’t involve rough and tumble.
• For older kids, encourage them to be involved when visiting the doctor and discussing treatment options.

Discovering your child has ITP can be a frightening experience for any family. But remember, most children get better within six months or less and serious consequences are extremely rare.

The Platelet Disorder Support Association would like to thank:

Julia Hyde; UptoDate® Clinical information service; Jonathan Drachman, MD, Puget Sound Blood Center, Seattle, WA; Divya-Devi Joshi, MD, Nemours Children’s Clinic, FL; Revathy Sundaram, MD, Long Island College Hospital, Brooklyn, NY; Michael Tarantino, MD, Hemophelia Center, Peoria, IL

You can order copies of this information in booklet form at http://www.pdsa.org/products/complementary.htm