ImmuneThrombocytopenic Purpura in Children
What is immune thrombocytopenic purpura (ITP)?
ITP is a blood disorder that causes a decrease in the number of platelets in the blood. Platelets help stop bleeding. So, a decrease in platelets can result in easy bruising, bleeding gums, and bleeding inside the body. The lower the platelet count, the greater the risk of bleeding.
ITP may be acute or chronic:
Acute thrombocytopenic purpura. This is most common in young children (2 to 6 years old). The symptoms may follow a viral illness, such as chickenpox. Acute ITP usually starts very suddenly. Symptoms usually go away in less than 6 months (often within a few weeks). Treatment is not usually needed. The disorder usually does not recur. Acute ITP is the most common form of the disorder.
Chronic thrombocytopenic purpura. This disorder can start at any age. The symptoms last at least 12 months. Adults have this form more often than children, but it does affect teens. Females have it 2 times to 3 times more often than males. Chronic ITP can recur often.
What causes ITP in children?
In most cases, the cause of ITP in children is unknown. Known causes include:
- Immune system problems
- Viral infections like chicken pox
- Some medicines or vaccines
What are the symptoms of ITP in children?
The symptoms of ITP are related to increased bleeding. Some children have very mild symptoms or none at all. Symptoms may include:
Purpura.This is the purple color of the skin after blood has "leaked" under it.
Bruising. A bruise is blood under the skin. Children with ITP may have large bruises from no known injury. Bruises can appear on the elbows and knees just from movement.
Petechia. Tiny red dots under the skin that are a result of very small bleeds.
- Bleeding in the mouth and/or in and around the gums
- Blood in urine or stool
- Vomiting with blood
- Bleeding with a head injury. This may be life-threatening in a child with ITP.
The symptoms of ITP may look like other medical problems. Always check with your child's doctor for a diagnosis.
How is ITP in children diagnosed?
Your child's healthcare provider will ask questions about your child's medical history and do a physical exam. Other tests may include:
Complete blood count, or CBC. A complete blood count checks the red and white blood cells, blood clotting cells (platelets), and sometimes, young red blood cells (reticulocytes). It includes hemoglobin and hematocrit and more details about the red blood cells.
- Normal platelet count is between 150,000 to 450,000. With ITP, the platelet count is less than 100,000. By the time significant bleeding occurs, the child may have a platelet count of less than 10,000.
Peripheral smear. A small sample of blood is examined under a microscope. Blood cells are checked to see if they look normal or not.
Bone marrow aspiration. To look at the production of platelets and to rule out any abnormal cells the marrow may be producing that could lower platelet counts.
How is ITP in children treated?
Your child’s healthcare provider will figure out the best treatment based on:
- How old your child is
- His or her overall health and medical history
- How sick he or she is
- How well your child can handle specific medications, procedures, or therapies
- How long the condition is expected to last
- Your opinion or preference
Your child's provider will likely refer you to a hematologist, an expert in blood disorders. Not all children with ITP require treatment. Some children recover without treatment. Blood tests and protection from bleeding may be all that is needed.
When treatment is needed, the two most common forms of treatment are steroids and immune globulin:
teroids. Brief treatment with steroid medication helps prevent bleeding by decreasing platelet destruction. Steroids can increase the platelet count in 2 weeks to 3 weeks.
Intravenousimmune globulin (IVIg). A single dose of IVIg to slow the destruction of platelets. It works more quickly than steroids (within 24 hours to 48 hours).
Anti-D or Rh immune globulin. This medication temporarily stops the spleen from destroying platelets. This is used very carefully because it may actually cause destruction of red blood cells.
Other treatments for ITP may include:
Rituximab. This is a type of antibody that helps to increase platelets.
High-dose dexamethasone. This is a type of steroid.
Splenectomy. The spleen is removed, since it is where most platelets are destroyed.
What are the complications of ITP?
Complications of ITP in children include:
- Serious bleeding
- Complications from medicines used to treat ITP
How is ITP managed?
To prevent bleeding consider the following:
- Pad the crib or toddler bed.
- Make sure your child wears a helmet and other protective pads when bike riding, skating, or skateboarding.
- Your child should avoid contact sports like soccer, football, rugby, and wrestling, as well as other high-injury activities.
- Your child should not take aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) that increase the chance of bleeding.
Talk with your child's provider about other ways to prevent injuries.
When should I call my child's healthcare provider?Call your child's healthcare provider if your child has worsening symptoms of bleeding.
Key points about ITP in children
- ITP is a blood disorder with decreased blood platelets, which may result in easy bruising, bleeding gums, and internal bleeding.
- The cause is usually unknown, but it may be an autoimmune disorder or follow a viral illness. It can also occur with certain medications or vaccinations.
- Treatment may not be needed. The most common treatments are immune globulin or corticosteroids.
Next stepsTips to help you get the most from a visit to your child’s healthcare provider:
- Before your visit, write down questions you want answered.
- At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you for your child.
- If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.
- Foster, Sara, RN, MPH
- MMI board-certified, academically affiliated clinician