• Reference Number: HEY1568/2025
• Departments: Haematology
• Last Updated: 31 July 2025

Introduction

This leaflet has been produced to give you general information about your condition and treatments.  Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and your doctor but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team caring for you.

What is ITP

Immune thrombocytopenia (ITP) is a medical term for an autoimmune disorder (immune) causing a shortage of platelets (thrombocytopenia) and bruising (purpura).

What is the cause of ITP

ITP is a disease in which the immune system mistakes platelets as being a threat and makes antibodies (proteins in the body) to destroy them. This can follow a virus, vaccination or certain medications, but for most people the cause is unknown.

ITP that occurs suddenly is known as acute ITP, if the platelet count remains low after 3 months it will be called persistent ITP, and if the platelet count has not returned to normal after 12 months it will be called chronic ITP. The severity of the condition is determined by adding the names severe or mild. Thus, for example, someone with chronic severe ITP would have had a troublesome condition with a very low platelet count for over a year.

How is ITP diagnosed

ITP is usually diagnosed by a blood test showing that only the platelet count is low, and the platelets, red blood cells and white blood cells all look normal under a microscope. A bone marrow biopsy (a small sample of bone marrow taken under local anaesthetic and examined under the microscope) may be taken at a later stage if the ITP continues but is not required for most people. Additional blood tests may be taken to exclude rare clotting or immune diseases that mimic ITP.

What are Platelets

There are three types of blood cell which are all formed in the bone marrow: red cells, white cells and platelets. Platelets, which are small and sticky circulate in the bloodstream to provide the initial plug to stop bruising and bleeding after an injury and stop blood leaking from blood vessels. Many people with ITP have a platelet count in single figures, and on rare occasions there are not enough circulating platelets to be counted. The number of platelets circulating in our bodies fluctuates all the time, and thus no two consecutive platelet counts are likely to be the same either in a healthy person or in an ITP sufferer. When treating ITP, we focus more on improving the symptoms of the disease rather than just increasing the number of platelets. If a platelet count is low on a blood test but there are no symptoms, we will not automatically start or alter treatment as this is unnecessary.

What is the difference between ITP and haemophilia

Haemophilia is inherited, meaning you are born with it and it is permanent, ITP is not inherited, and can go into remission. Haemophilia patients are deficient in one of the 13 clotting factors which act together to form a blood clot. ITP patients are short of platelets which work independently as the initial plug to stop blood leakage, but the rest of the clotting mechanism works normally. Platelet infusions are only used in emergencies as transfused platelets, like the patient’s own platelets, are destroyed by their immune system in a matter of hours.

What is the incidence of ITP

In the UK about 3,000 to 4,000 of the population have ITP at any one time, and it is not more prevalent in any gender, racial or ethnic group.

What are the symptoms of ITP

Please read the information leaflet. Share the information it contains with your family (if you wish) so that they can be of help and support. There may be information they need to know, especially if they are taking care of you.

Bleeding is the most common symptom of a low platelet count, but it usually happens when platelet levels drop to a very low number. Most people with ITP have no symptoms and only find out they have it through a routine blood test.

Fatigue is another common symptom, especially when platelet levels are very low. If bleeding occurs, iron levels may drop, making fatigue worse. Fatigue usually improves when ITP gets better.

List of symptoms of ITP:

Common

• Pinprick rash of blood spots called petechiae.
• Bruising
• Nosebleeds
• Gum bleeds
• Black mouth blisters
• Fatigue
• Heavy periods

Rare

• Blood in the eyes.
• Bleeding from the ears.
• Blood in the urine.
• Other serious bleeding.

How is ITP treated

ITP does not always need treatment, even if platelet levels are low. In most cases, doctors simply monitor the condition. However, treatment is necessary in certain situations, such as severe bleeding or before surgery when a higher platelet count is required.

If treatment is needed, medications help raise platelet levels to reduce bleeding risks or ensure safe surgery. The goal is to increase platelets to a safer level, not necessarily to a normal range.

Medications to treat ITP:

Initial treatment

The first line treatment for ITP is usually steroids, such as Prednisolone. Steroids help stop the body from attacking the platelets. They are given for a short period of time, with the dose gradually reduced before stopping completely. In some cases, another treatment called Intravenous Immunoglobulin (IVIg, under various brand names) may be needed. This is given through an infusion and would involve attending the day unit at the Queens Centre.

Second line treatment

If steroids do not work, other medications can help increase platelet production. These include:

Romiplostim- a once weekly injectable medication you can learn to give yourself.

Avatrombopag – a daily tablet.

Eltrombopag – a daily tablet, but with some dietary restrictions.

Fostamatinib – a tablet taken twice a day that helps prevent platelet destruction.

Third-line treatment

If the above treatments do not work, Rituximab can be given. This is an intravenous medication which is given once a week for 4 weeks in the day unit at the Queens Centre.

Other treatments

If none of the above treatments work, other medications such as immune-suppressing drugs or oral chemotherapy may be considered.

Surgical treatments

If all treatments fail, surgery to remove the spleen (splenectomy) may be an option.

Supportive treatment to manage bleeding episodes

Tranexamic acid may be used to manage bleeding or during a minor procedure, such as dental extractions.

Hormone preparations and/or tranexamic acid may be prescribed to women having heavy periods.

Platelet transfusions may need to be used to support during active bleeding or during surgery, but they are ineffective as a long-term treatment for ITP. This is because the immune system destroys transfused platelets as quickly as the body’s own platelets.

When to seek help

You should contact the hospital in the following circumstances:

• A prolonged (over 30 minutes) nosebleed which will not stop despite pinching the nose
• Prolonged gum bleeding
• Blood in the faeces or urine
• A heavy blow to the head
• Persistent or severe headache with the loss of vision, vomiting or drowsiness
• Very heavy periods (e.g. Lasting 8-10 days, changing more than 9 tampons/pads per day, changing protection during the night, passing clots on two consecutive days
• A sudden increase in bruising.
• Before any planned procedure or operation
• If you attend the hospital for any reason, tell the medical team that you have ITP

If you experience any of the above, then please contact the haemostasis nursing team for advice on tel: 01482 461403 (working hours between 8 am-6 pm Monday – Friday (not including bank holidays).  You can also contact us by email on

hyp-tr.bleedingdisordersadvice@nhs.net

For Out of office hours and bank holidays please call the on-call haematologist via the hospital switchboard on tel: 01462 875875.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the haemostasis nursing team on 01482 461403 (working hours between 8am and 6pm Monday to Friday).