When do you need treatment for ITP?

Overview

Thrombocytopenia happens when your bone marrow doesn’t make enough platelets (bottom), the blood cells that help stop bleeding.

What is thrombocytopenia?

Thrombocytopenia (pronounced “THROM-bo-sigh-toe-PEE-ne-ah”) occurs when your bone marrow doesn’t make enough platelets. Platelets are blood cells that form blood clots to help stop bleeding. If you have thrombocytopenia, you may bleed a lot, and the bleeding may be hard to stop.

Thrombocytopenia often affects people with certain medical conditions, like autoimmune disease or who take certain medications. Healthcare providers typically treat thrombocytopenia by treating the underlying condition and/or changing the medication that caused the issue.

How common is this condition?

People may have thrombocytopenia and not realize it because their symptoms are so mild. That’s why healthcare providers aren’t sure exactly how many people have this condition. They do know a related condition, immune thrombocytopenia, affects 3 to 4 in 100,000 children and adults. About 5% of people who are pregnant develop mild thrombocytopenia just before giving birth.

What are the complications of thrombocytopenia?

People with severe thrombocytopenia may have an increased risk of developing the following conditions:

Severe internal bleeding: Thrombocytopenia may cause gastrointestinal bleeding or bleeding in your brain. Bleeding into your brain is a life-threatening issue.
Heart attack: Thrombocytopenia may decrease the amount of blood flow to your heart.

What are normal platelet levels?

A normal platelet count or level in adults ranges from 150,000 to 450,000 platelets per microliter of blood. Thrombocytopenia levels are:

Mild thrombocytopenia: Platelet levels between 101,000 and 140,000 per microliter of blood.
Moderate thrombocytopenia: Platelet levels between 51,000 and 100,000 per microliter of blood.
Severe thrombocytopenia: Platelet levels between 51,000 and 21,000 microliters of blood.

Symptoms and Causes

What are thrombocytopenia symptoms?

Some people with mild cases of thrombocytopenia don’t have symptoms. When they do, one of the first symptoms is a cut or nosebleed that won’t stop bleeding. Other symptoms include:

Bleeding gums: You may notice blood on your toothbrush and your gums may appear swollen.
Blood in poop (stool): Your poop may appear very dark.
Blood in urine (pee): If toilet water is pale pink after you pee, you may have blood in your urine.
Blood in vomit: Hematemesis, or blood in vomit, is a sign of bleeding in your upper gastrointestinal tract.
Heavy menstrual periods: If your periods last longer than seven days or you’re bleeding more than usual, you may have menorrhagia.
Petechiae: This symptom appears as tiny red or purple dots on your lower legs that resemble a rash.
Purpura: You may have red, purple or brown spots on your skin. This happens when small blood vessels under your skin leak blood.
Bruises: Bruises happen when blood pools under your skin. You may notice you’re developing bruises more easily than usual.
Rectal bleeding: You may notice blood in the toilet water or after you wipe.

What causes thrombocytopenia?

Thrombocytopenia causes fall into one of three categories:

Your bone marrow doesn’t make enough platelets. This may happen if you have blood cancers like leukemia or lymphoma.
Your bone marrow makes enough platelets, but your platelet supply runs low because you have conditions that use up your platelet supply or destroy your platelets.
Your spleen traps platelets so they can’t circulate through your bloodstream. Normally, your spleen stores about one-third of your platelet supply.

Specific factors affecting platelet supply include:

Autoimmune diseases: Autoimmune diseases, like immune thrombocytopenia (ITP), lupus and rheumatoid arthritis, that attack your immune system may destroy platelets.
Blood cancers: Leukemia and lymphoma may damage your bone marrow and affect its ability to make enough blood cells, including platelets.
Cancer treatments: Treatments — including chemotherapy and radiation therapy — sometimes destroy stem cells that would have become platelets.
Thrombotic thrombocytopenic purpura (TPP): This blood disorder causes blood clots in small blood vessels throughout your body. Platelets make blood clots. Your platelet supply may run low if you have TPP or a similar condition, disseminated intravascular coagulation, which uses up platelets.
Infections: Bacterial and viral infections may lower your platelet levels.
Alcohol use disorder: Alcohol slows platelet production. Drinking a lot of alcohol may cause your platelet level to drop.
Toxic chemicals: Exposure to toxic chemicals, including arsenic, benzene and pesticides, may affect your platelet level.
Medications: Antibiotics that treat bacterial infections, medication for seizures and heart conditions, and the blood thinner heparin may affect platelet levels.

Diagnosis and Tests

How do healthcare providers diagnose thrombocytopenia?

Healthcare providers will do a physical examination. They’ll check for bruises, rashes and other thrombocytopenia symptoms. They’ll ask about your medical history, including any medications you take. They may do tests including:

Complete blood count (CBC): Providers will check your platelet levels and your white and red blood cell levels.
Peripheral blood smear: Providers examine your platelets under a microscope.
Blood clot test: A blood clot test measures the time it takes blood to clot. These tests include partial thromboplastin time (PTT) and prothrombin time (PT) test.
Bone marrow biopsy: If blood tests show a low platelet count, your healthcare provider may do a bone marrow biopsy.

Management and Treatment

How do healthcare providers treat thrombocytopenia?

You might not need treatment if a low platelet count isn’t causing significant issues. Often, healthcare providers can improve platelet counts by treating the underlying cause. This approach may involve changing your medications. Other treatments include:

Steroids: These medications may boost your platelet production.
Blood transfusion: If your platelet level is very low, your healthcare provider may use blood transfusions to temporarily increase your platelet levels. Transfusions may boost levels for about three days.
Splenectomy: This is surgery to remove your spleen. Your surgeon may do this if tests show your spleen is trapping large numbers of platelets. People who have splenectomies have an increased risk of developing infections. They may receive vaccinations to prevent infections.

Prevention

How can I reduce my risk of developing thrombocytopenia?

The most important thing is to understand if you have medical conditions or take medication that increases your risk of developing thrombocytopenia. If you do, ask your healthcare provider if there are medications or activities you should avoid.

Outlook / Prognosis

What can I expect if I have this condition?

Many things can cause your platelet levels to drop so you develop thrombocytopenia. For example, you may have an autoimmune disease that affects your platelet levels. You may have low platelet levels because you drink lots of alcohol or are exposed to certain toxic chemicals.

Bottom line — once your healthcare provider finds out why your platelet levels are low, they’ll take steps to help you. If you have thrombocytopenia, ask your healthcare provider what caused the issue and what treatment or lifestyle changes they recommend.

If your provider recommends treatment, you may need ongoing treatment to maintain a normal platelet level. Your provider will monitor your overall health and platelet levels.

Living With

How do I take care of myself?

If you have thrombocytopenia, here are some suggested ways to take care of yourself:

Make healthy lifestyle changes: If you smoke, quit. Smoking increases your risk of blood clots. If you drink alcohol, do so in moderation. Heavy alcohol use may affect platelet levels. Practice good dental hygiene to avoid dental treatments that may cause bleeding.
Take care with over-the-counter (OTC) medication: Some OTC medications contain ibuprofen or aspirin that may make your blood too thin. Talk to your provider before using supplements and herbal remedies.
Avoid activities that may cause bruising and bleeding: Most contact sports, like football, soccer or basketball, increase the chance you’ll have an injury that involves bleeding. Ask your healthcare provider about activities you can do without increasing your risk of injury.
Travel safe: Wear your seatbelt while driving or riding in a vehicle.
Tell your healthcare providers about your medications: You may receive medication to thin your blood. If you have surgery or dental procedures, tell your providers about your medications before your surgery or procedure.

When should I seek care?

Thrombocytopenia symptoms can develop very quickly or over time. It may also cause bleeding in many parts of your body. Seek medical care if:

You notice changes in your body that could be thrombocytopenia symptoms, such as new bruises and unusual bleeding.
You have a fever or other signs of infection. If you had a splenectomy, you’re at increased risk of infection.

What questions should I ask my healthcare provider?

You may want to ask your healthcare provider:

Why did I get thrombocytopenia?
What’s the best treatment for me?
Are there any treatment risks or side effects?
What changes can I make to minimize bleeding and bruising?
Should I watch for signs of complications?

A note from Cleveland Clinic

Thrombocytopenia — low platelet levels — may increase your risk of issues like excessive bleeding and bruising. Severe thrombocytopenia increases your risk of internal bleeding or heart attack. If you have this condition, it’s important to understand why you have low platelet levels. Your healthcare provider can explain what’s causing the low platelet count and discuss treatment options. They’ll also discuss lifestyle changes that may boost your platelet levels.

When should you start treatment for ITP?

The majority opinion is that patients should consider treatment, if they are not bleeding, only when platelet counts are less than 30,000. Keith McCrae, MD, states that a sedentary person's platelet count can go quite low, perhaps even below 20,000, before therapy is required.

Does ITP need to be treated?

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).

When should I worry about ITP?

Blood in the vomit, urine, or stool. Bleeding in the head. This is the most dangerous symptom of ITP. Any head injury that occurs when there are not enough platelets to stop the bleeding can be life threatening.

What happens if you dont treat ITP?

The specific symptoms of ITP are affected by your platelet count: The lower your count, the more likely you are to have spontaneous and unexpected bleeding, both internally and externally. Without treatment to correct platelet counts, bleeding can become severe and life threatening.