Idiopathic Thrombocytopenic Purpura – Diagnosis and Treatment
Diagnosis
Doctors often begin diagnosing immune thrombocytopenia by reviewing symptoms such as easy bruising, petechiae (small red or purple spots), or mucosal bleeding. A complete blood count (CBC) is ordered to confirm a low platelet count (thrombocytopenia).
A peripheral blood smear is examined to rule out other hematologic conditions, such as thrombotic thrombocytopenic purpura or pseudothrombocytopenia caused by platelet clumping. This test helps verify that the low platelet count is genuine and not due to laboratory error.
In rare cases, especially in older adults or when other abnormal blood findings are present, doctors may recommend a bone marrow biopsy to evaluate megakaryocyte numbers and function and to exclude bone marrow failure, leukemia, or other causes of thrombocytopenia.
Additional tests may include screening for viral infections (such as hepatitis C or HIV), autoimmune markers, or Helicobacter pylori if clinically indicated.
Diagnosis is primarily one of exclusion, meaning other causes of low platelets must be ruled out before confirming immune thrombocytopenia.
Treatment
Medicines and Drug Therapy
Doctors often start by reviewing any current drugs or supplements to avoid anything that may raise the risk of bleeding, such as aspirin, ibuprofen, or ginkgo biloba. They aim to safely increase platelet levels when counts are too low.
Common medicines to manage platelet counts include:
| Drug Type | Main Purpose |
|---|---|
| Corticosteroid | Increase platelet count |
| Immune globulin | Rapid platelet boost |
| Thrombopoietin receptor agonist | Stimulate platelet production |
| Monoclonal antibody | Suppress immune response |
| Syk inhibitor | Used when others fail |
| Thrombopoietin receptor agonist | Increase platelet count |
| Immunosuppressant | Lower immune attack |
- Steroids: Patients usually take these by mouth. Steroids can increase platelets, but long-term use may cause side effects such as high blood sugar, bone problems, or infections.
- Immune Globulin (IVIG): Doctors often use this if steroids do not work or if a quick boost in platelets is needed, especially before surgery or if serious bleeding occurs. Healthcare providers give IVIG through a vein (IV), and its effects last about a week or two.
- Drugs That Help the Body Make More Platelets: Thrombopoietin receptor agonists encourage the bone marrow to produce more platelets. Doctors sometimes use these if other treatments have not helped, but they may increase blood clot risks.
- Other Immune-Modifying Treatments: A monoclonal antibody targeting B cells can reduce immune activity against platelets but may also lessen the body’s response to vaccines, leading to weaker protection from some diseases in the future. Another option is a spleen tyrosine kinase (SYK) inhibitor, which may be considered for individuals with immune thrombocytopenia (ITP) that does not respond to other treatments.
- Immunosuppressants: Doctors prescribe these drugs, in some cases.
Surgical Removal of the Spleen
If medicine does not control ITP, doctors may recommend removing the spleen, known as a splenectomy. The spleen destroys most platelets, so removing it can quickly raise the platelet count and help prevent bleeding.
Not everyone improves after this surgery. People without a spleen have a higher risk of getting infections in the future, so vaccinations and careful medical follow-up become important.
Urgent Care for Serious Bleeding
When ITP causes major or life-threatening bleeding—such as internal bleeding, severe nosebleeds, or intracranial hemorrhage—doctors provide emergency care. This can include:
- Platelet Transfusions: Healthcare providers give blood that contains extra platelets to help stop bleeding.
- High-Dose Steroids and IVIG: Doctors may give both by vein (IV) to act fast when time is critical.
- Hospitalization: Patients with serious or persistent bleeding may need to stay in the hospital for closer monitoring and care.
Helpful Habits and Self-Care Tips
People living with immune thrombocytopenia should take steps to lower their risk of bleeding and bruising. They should avoid activities like boxing, football, or martial arts, as head injuries from these can lead to bleeding problems.
Watching for signs of infection, such as fever, is vital—especially for those without a spleen, since infections may be more dangerous.
Use this table as a quick guide:
| Do’s | Don’ts |
|---|---|
| Choose gentle activities | Skip contact sports |
| Look for easy bruising, nosebleeds | Do not ignore bleeding gums or blood in urine |
| Ask a doctor before new medicines | Avoid aspirin and ibuprofen |
Always talk to a doctor before starting new medications to help prevent problems like fatigue or increased bleeding.
Getting Ready for Your Medical Visit
Steps to Take Before Seeing Your Doctor
It can help to be well-prepared for a visit about immune thrombocytopenia or low platelets, especially if you have a complex medical history or other health factors like viral infections, autoimmune concerns, or past diagnoses of conditions such as Evans syndrome or antiphospholipid syndrome.
Bringing along a family member or friend may help you remember details from your discussion.
Recommended preparations include:
- Write Down Symptoms: Note when each symptom started and if they relate to new infections, recent viral illness, or other changes in your health. Even if you feel fine (asymptomatic), mention any recent fevers, unusual bruising, or bleeding.
- List Recent Illnesses and Conditions: Include information about any viral infections, past or current HIV infection, or other immune conditions like immune hemolytic anemia.
- Record Medical Treatments or Procedures: Mention recent hospital stays, blood transfusions, invasive procedures, or clinical trial participation.
- Document Medications and Supplements: Write a list of every medicine, vitamin, and supplement you currently take with their exact doses. Also list any recent changes.
Questions to ask your healthcare provider:
| Topic | Example Questions |
|---|---|
| Platelet count | How low are my platelets? |
| Cause and duration | What might be causing my low levels? Is this likely to last? |
| Testing and treatment options | Do I need more tests? What treatments do you recommend? |
| Side effects and next steps | What might happen if I do nothing? |
| Special concerns | Are restrictions needed for invasive procedures or to lower my risk of thrombosis? |
