Idiopathic thrombocytopenic purpura (ITP)

  • Idiopathic thrombocytopenic purpura (id-ee-oh-path-ic throm-bo-sigh-toe-penic per-per-a), or ITP, is a bleeding disorder resulting from a shortage of platelets in the blood. Platelets are the blood cells that help the blood to clot. ITP is caused by the body's own immune system mistakenly destroying platelets, and is often triggered by the common cold.

    If a child has a shortage of platelets, then they will bruise easily and may have other bleeding problems.

    One in 10,000 children have ITP, so it is quite rare. While ITP may sound worrying to parents, the risk of any serious complication from ITP is very low. In most children the condition will settle down quite quickly – often without needing any treatment. The platelet count is often up to safe levels within a week or two, but it may take longer to fully return to normal.

    In a very small number of children, the platelet count does not return to normal, even after six to 12 months. In these cases, doctors will determine the appropriate treatment for your child.

    Signs and symptoms of ITP

    If your child has ITP, they may have relatively quick onset of:

    • bruising (large bruises or tiny bruise-like dots, especially on the lower limbs)
    • nosebleeds or mouth bleeding
    • petechial rash (pinpoint red spots) on the skin.

    When to see a doctor

    If your child has any of the symptoms of ITP, take them to the GP. While it is possible to diagnose ITP just by examining your child, a blood test will be performed to confirm the diagnosis and exclude other potential problems.

    If your child is unwell with a fever and a skin rash (small bright red spots or purple spots or unexplained bruises) that does not turn to skin-colour (blanch) when you press on it, this may be a sign of meningococcal infection (see our fact sheet Meningococcal infection).

    Treatment for ITP

    There are several treatment options for ITP.

    • No treatment – a good option for many children as the condition will often get better by itself.
    • Steroids (prednisolone) – this medication can raise the platelet count more quickly than what would occur with no treatment. 
    • Intravenous immunoglobulin (IVIg) – this is a type of blood transfusion that is sometimes used. It stops the body from destroying its own platelets.

    The doctor will discuss the best treatment option for your child. Your child may need blood tests every few days to monitor the progress of the condition. It is important that you attend all follow-up appointments that your doctor recommends.

    Care at home

    While your child's platelet count is very low, they may be advised to avoid activities that might cause bruising or bleeding (e.g. avoid climbing equipment at school or not ride their bicycle). As the platelet count rises, more activity will be allowed. Contact sports and other rough physical activity should be avoided until your child's doctor advises otherwise.

    Children with ITP should not take aspirin or ibuprofen. Paracetamol is quite safe to use if your child needs pain relief.

    What causes ITP?

    The disease is caused when the body produces antibodies that attack platelets, causing them to be destroyed in the spleen. Antibodies are proteins that are normally produced by the immune system. Doctors do not fully understand why the body has this reaction. However, in children, ITP sometimes develops after a viral infection (e.g. a cold), which seems to be a trigger for the production of the abnormal antibodies.

    Key points to remember 

    • ITP is a bleeding disorder caused when the blood has difficulty clotting due to a shortage of platelets.
    • In most cases, ITP will settle quickly with no treatment. Serious complications with ITP are very rare.
    • While your child's platelet count is low, your child should avoid activities that can cause bruising or bleeding.

    For more information

    Common questions our doctors are asked

    Is it safe to give my child prednisolone?

    You may have heard about possible side effects from prednisolone. These side effects happen when the medicine is given for months at a time, and will not happen when the prednisolone is given for just a few days or weeks, especially if the dose is slowly weaned (lowered before stopping).

    Are blood products safe to give children? What are the possible side effects of the intravenous immunoglobulin?

    All intravenous immunoglobulin products are tested and screened to protect patients from diseases, and they undergo processes that destroy viruses. The risk of infection is very low. Mild side effects sometimes occur, such as tiredness, mild headache, nausea, stomach and back pain. Very rarely, more serious side effects occur, such as wheezing, severe headache or blood clots. Your child will be carefully monitored during the transfusion.

    After my child recovers from ITP, are they likely to get it again? Will they have bleeding problems in the future?

    In some cases, ITP will happen again (months or years after the first episode has resolved), often after a viral illness. If your child recovers fully between episodes, then each occurrence will be managed with regular ITP treatment. If the platelet count stays low for six months, your child will need to be managed by a paediatrician or paediatric haematologist (blood specialist).

    Developed by The Royal Children's Hospital General Medicine and Haematology departments. We acknowledge the input of RCH consumers and carers.

    Reviewed June 2018.

    This information is awaiting routine review. Please always seek the most recent advice from a registered and practising clinician.

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