Your child has been diagnosed with Immune Thrombocytopenia Purpura (ITP) and your doctor has explained the disease, its cause and treatment plan. This may have been a very stressful experience and you may not remember everything you have heard or still have questions. This handout has been designed to help you recall the facts that were presented to you.

Your child may seem perfectly normal except for some bruises and some small, pinpoint red spots under the skin. These spots are called “petechiae,” which are caused by very small amounts of blood leaking out of the tiny blood vessels under the skin. You may have noticed that the petechiae and bruises were especially visible after a warm bath. Other than the petechiae and bruises, your child seems normal and has no fever or pain. While your child may suffer from a bloody nose or bleeding from the mouth, serious bleeding is almost never seen.

ITP can be better understood by looking at the three parts of the name: 1. In the past, “I” stood for idiopathic, which means the cause of the problem is a mystery. This is the old name for this condition. Today, we know that the immune system is responsible for the problem, so the name has been changed to Immune Thrombocytopenia Purpura. The immune system usually protects the body by identifying substances that do not belong and labeling them for removal. 2. Thrombocytopenia means that there are not enough thrombocytes, or platelets, in the blood. Platelets are one part of the blood that causes the blood to clot. If the blood does not clot as it should, cuts in the skin will keep bleeding, gums bleed easily when teeth are brushed, skin is bruised very easily and little red dots can be seen under the skin. 3. Purpura, which sounds something like “purple,” means big bruises. In ITP, the body’s immune system attacks its own platelets. When there are not enough platelets, a person may bruise.

The body’s immune system produces a protein called an antibody, which sticks onto the platelets. This antibody tags onto the platelets, causing the platelet to be labeled by the body’s defense system as not being part of the body. The spleen attacks the tagged platelet and destroys it. Why the body begins to produce antibodies against its own platelets is unknown.

Approved by the MemorialCare Miller Children’s & Women’s Hospital Long Beach Patient & Family Education Committee. 1 ITP is a fairly common bleeding disorder. It occurs frequently in both boys and girls aged two to six-years-old. It is most commonly seen in the winter and spring months. In more than half the cases, the child has had a viral infection or an immunization within the last six weeks.

The doctor will do a very careful physical examination of your child and all the areas of bleeding will be checked. A blood test will be performed to determine platelet count and to be sure that other parts of the blood are normal. The doctor may need to do a bone marrow aspiration.

This is a fairly simple test that the doctor conducts to make sure your child is producing enough platelets. Platelets, and all parts of the blood, are made in the bone marrow. By taking a small amount of the bone marrow out with a special needle, the doctor will be able to see if the “factory” for the blood is doing what it is supposed to do. If needed, your child’s doctor or nurse will explain this procedure to you and help prepare you and your child for the test. This test is not always needed.

The most important part of treating ITP is preventing problems caused by bleeding. Your child’s activities will need to be restricted to prevent bleeding until platelet count improves. Special care should be taken to prevent falling and injury to the head. No aspirin should be given to your child for any reason, because aspirin prevents platelets from working well. Also, do not give medications containing ibuprofen until your child has completely recovered from ITP. • RhO Immune Globulin (WinRho SD): This is a special product that gives the antibody a place to attach to the red blood cells instead of the platelets. If your child’s blood type is RH+, and if their red blood cell count (measured as hemoglobin) is high enough, they can receive WinRho SD through a small vein. It is given over only a few minutes. Your child’s hemoglobin may drop a little, but this should not be a problem. The platelet count will usually start to rise in one to two days, with the peak in 7 - 14 days. This should last for about 30 days, which is usually long enough for the ITP to disappear. • Steroids: The doctor may prescribe a short course of steroids (Prednisone® or Decadron®) for your child. Steroids given for a short period of time usually do not cause serious side effects. The doctor will discuss this treatment with you. • Immune Globulin: Your child’s doctor may decide to treat your child with Immunoglobulin (IgG). This must be given through the veins and usually requires a brief hospital stay. • Platelets: Platelet transfusions usually are not given to children with ITP because the body will destroy the new platelets just as rapidly as it destroyed the platelets made by your child’s bone marrow.

2 More than 50 percent of children with ITP will have a normal platelet count within one to three months. Eighty to 90 percent of children will be normal within 12 months. ITP rarely returns. A normal platelet count is between 150,000 and 400,000 (usually the number is abbreviated to the number before the three 0s, or 150 - 400). At the time of the diagnosis, your child’s platelet count may have been as low as two (thousand). You will notice platelet count will rise when your child responds to the treatment. It is important to not be concerned with the actual number, but to think of the platelet count in groups of 50 (thousand). A platelet count of five is not significantly different from a platelet count of 25. Both are less than 50.

Although the laboratory tests can show a very small number of platelets, the platelets that are present are very effective at causing the blood to clot. Bone marrow helps by producing platelets at a much higher rate than usual. When the platelet count drops below a certain level, your child’s doctor may prescribe treatment to return the platelet count to a reasonably safe level. Your child’s doctor will explain the platelet count that will be accepted for your child.

ITP is not contagious. No one can catch it from your child and your child did not catch it from anyone else. If you have further questions or would like more information about ITP, please call (562) 728-5000.

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