To diagnose immune thrombocytopenia, your doctor will try to exclude other possible causes of bleeding and a low platelet count, such as an underlying illness or medications you or your child may be taking.
Blood tests can check the levels of platelets. Rarely, adults might need a bone marrow exam to rule out other problems.
People with mild immune thrombocytopenia may need nothing more than regular monitoring and platelet checks. Children usually improve without treatment. Most adults with ITP will eventually need treatment, as the condition often becomes severe or long term (chronic).
Treatment may include a number of approaches, such as medications to boost your platelet count or surgery to remove your spleen (splenectomy). Talk with your doctor about the risks and benefits of your treatment options. Some people find that the side effects of treatment are more burdensome than the effects of the disease itself.
Your doctor will talk with you about over-the-counter medications or supplements you take and whether you need to stop using any that might inhibit platelet function. Examples include aspirin, ibuprofen (Advil, Motrin IB, others) and ginkgo biloba.
Medications to treat ITP may include:
- Steroids. Your doctor will likely start you on an oral corticosteroid, such as prednisone. Once your platelet count is back to a safe level, you can gradually discontinue taking the drug under the direction of your doctor. Long-term use of these medications isn't recommended because they can increase your risk of infections, high blood sugar and osteoporosis.
- Immune globulin. If corticosteroids don't help, your doctor may give you an injection of immune globulin. This drug may also be used if you have critical bleeding or need to quickly increase your blood count before surgery. The effect usually wears off in a couple of weeks.
- Drugs that boost platelet production. Medications such as romiplostim (Nplate) and eltrombopag (Promacta) help your bone marrow produce more platelets. These types of drugs can increase your risk of blood clots.
- Other drugs. Rituximab (Rituxan, Truxima) helps increase your platelet count by reducing the immune system response that's damaging your platelets. But this drug also can reduce the effectiveness of vaccinations, which may be needed if you later choose surgery to remove your spleen.
If your condition is severe or persists despite initial drug treatment, your doctor may suggest surgery to remove your spleen. This quickly eliminates the main source of platelet destruction in your body and improves your platelet count, though it doesn't work for everyone. Living without a spleen permanently increases your susceptibility to infection.
Although rare, severe bleeding can occur with ITP. Emergency care usually includes transfusions of platelet concentrates. Steroids and immune globulin may also be given through a tube in a vein.
Lifestyle and home remedies
If you have immune thrombocytopenia, try to:
- Avoid contact sports. Depending on your risk of bleeding, head impacts during sports like boxing, martial arts and football could cause bleeding in your brain. Talk to your doctor about what activities are safe for you.
- Watch for signs of infection. If you've had your spleen removed, be alert for any signs of infection, including fever, and seek prompt treatment. Infections can be more serious in people without spleens.
- Use caution with over-the-counter medications. Nonprescription drugs such as aspirin and ibuprofen (Advil, Motrin IB, others) can impair platelet function.
Preparing for your appointment
Because a low platelet count may not cause symptoms, the problem is often discovered when you have a blood test for another reason. To diagnose immune thrombocytopenia, your doctor is likely to order further blood tests that require drawing a small amount of blood from a vein in an arm. He or she may also refer you to a specialist in blood diseases (hematologist).
What you can do
Here are some steps you can take to get ready for your appointment:
- List any symptoms you're experiencing, including those that seem unrelated to the reason for which you scheduled the appointment.
- List key personal information, including major stresses, life changes, and recent illnesses or medical procedures, such as a blood transfusion.
- List all medications, vitamins and supplements that you're taking, including doses.
- Ask a family member or friend to come with you. In addition to offering support, he or she can write down information from your doctor or other clinic staff during the appointment.
- List questions to ask your doctor. Preparing a list of questions can help you make the most of your time together.
Questions about ITP may include:
- How many platelets do I have in my blood?
- Is my platelet count dangerously low?
- What is causing my ITP?
- Do I need more tests?
- Is this condition temporary or long lasting?
- What treatments are available, and what do you recommend?
- What will happen if I do nothing?
- What are the possible side effects of the treatments you're suggesting?
- Are there any restrictions that I need to follow?
- Is there a generic alternative to the medicine you're prescribing?
- Do you have any brochures or other printed material that I can take with me? What websites do you recommend?