Immune thrombocytopenia(ITP) is an autoimmune disease that can cause excessive bruising or bleeding due to a reduced number of platelets in the blood.1,2

Platelets are the tiny blood cells produced in the bone marrow that help blood clot and stop bruising and bleeding after an injury.1,2

If there aren’t enough platelets in the blood, bruising may occur more easily and bleeding may become harder to stop.2

What causes ITP?

ITP can follow a virus, vaccination or treatment with some medications, but for most people the cause is unknown.1

ITP is more common in women than men. In the UK, ITP affects approximately 3,000 to 4,000 members of the population at any one time and is not specific to any racial or ethnic group.1,2

Some people who have ITP have other autoimmune conditions like rheumatoid arthritis, hepatitis or lupus. People with these medical issues may need their ITP treated slightly differently.2

What are the symptoms of ITP?

Those suffering from ITP may experience one or more of the following symptoms:1

  • Purple bruises known as purpura
  • Small red bumps on the skin called petechiae
  • Bleeding that is hard to stop
  • Bleeding from gums
  • Blood in stools or urine
  • Heavy periods (females)

Data from our I-WISh survey showed that ITP has a significant physical and emotional burden on those in the UK, with:3

  • 48 percent of UK patients reporting fatigue as being the most common symptom they experience
  • 72 percent saying that ITP impacts their energy levels
  • 68 percent saying the condition affects their ability to exercise; and
  • 60 percent reporting that ITP impinges on their ability to carry out daily tasks

How is ITP diagnosed?

Currently there is no diagnostic test for ITP. Instead, ITP is normally diagnosed by the exclusion of other conditions that could cause a low platelet count.2,3

The first step is a blood test. After diagnosis, a patient is considered to be in one of three phases depending on how long the low platelet count has lasted: acute (0-3 months), persistent (3-12 months) or chronic (12 months or longer).1

Examination of the bone marrow biopsy together with additional blood tests may be taken at a later stage if ITP continues. Additional blood tests could be taken at diagnosis to exclude diseases similar to ITP or other causes for the low platelet count. If the bone marrow has normal numbers of platelet-producing cells (megakaryocytes) and other blood tests are normal, then chronic ITP may be diagnosed.1

What is the difference between ITP and haemophilia?
ITP can be confused with haemophilia, a genetic disorder where the blood doesn’t clot properly.

Here are the main differences between the two:1

  • Haemophilia is inherited, ITP is not and can go into remission
  • Haemophilia patients are deficient in one of the chemicals which trigger the formation of a blood clot; however
  • ITP patients have reduced platelets. The rest of the clotting mechanism works normally.

What is the goal of ITP treatment?

The main goal of ITP treatments is to increase the platelet counts to allow normal clotting and manage symptoms of ITP. There is currently no cure for the disease but several treatment options are available.1,2

Treatment should be tailored to the individual, and people should talk with their doctor about the risks and benefits associated with each option.2

If there are no signs of bleeding and the platelet count isn't too low, treatment may not be necessary.1

In the case of extremely low platelet counts, it may become necessary for patients to be admitted to hospital to receive platelet transfusions to prevent bleeding and stabilise platelet levels.2

Abbreviations: ITP, immune thrombocytopenia; I-WISh, ITP World Impact Survey.

References

  1. Guy’s and St Thomas’ NHS Foundation Trust. (2016). Immune Thrombocytopenia [Fact sheet]. Retrieved from: https://www.guysandstthomas.nhs.uk/resources/patient-information/haemato... Last Accessed: 19th September 2019.
  2. Oxford University Hospitals NHS Trust. ITP Information for Patients (2015) [Fact sheet]. Retrieved from: https://www.ouh.nhs.uk/patient-guide/leaflets/files/12388Pitp.pdf Last Accessed: 02 October 2019.
  3. Cooper N, et al. Burden of disease in Immune Thrombocytopenia (ITP): The initial results for UK patients from the ITP World Impact Survey (I-WISh). The British Society of Haematology. 2018. Abstract BSH18-289.
ONC19-C139a March 2020.
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