Immune thrombocytopenia (ITP) is a bleeding disorder caused by a shortage of platelets in the blood. Platelets are small cells in the blood that form a clot to help stop bleeding and bruising when a blood vessel is damaged. Children with ITP do not have enough platelets to plug the source of bleeding. Newly diagnosed ITP is not common in children, affecting 1-3 in every 10,000 children.

What causes ITP?

The exact cause of ITP is unknown, but it involves activation of the immune system. Once activated, the body's own immune system mistakenly destroys platelets in the spleen and elsewhere throughout the body. This is known as an “autoimmune” disorder. Possible triggers for ITP may include viral infections.

Signs and symptoms

The main signs and symptoms of ITP include:

  • easy bruising
  • red pinpoint spots on the skin (known as petechiae)
  • nose or mouth bleeding
  • excessive bleeding or bruising with injuries
  • prolonged menstrual bleeding in young women.

How is ITP diagnosed?

ITP is diagnosed through a combination of the child’s medical history, a physical examination and blood tests showing a low number of platelets. The diagnosis can usually be made based off this information alone without the need for further investigations.

Treatment

Most children with ITP will get better by themselves usually within 12 months of diagnosis. The management of ITP is not focused on the platelet number but treating any serious bleeding symptoms your child has.

It is important to note that treatments used in ITP may have side effects, and although they may increase the platelet count while your child is being treated, they do not alter their recovery from ITP. Children with no or minor bleeding or bruising may not require any treatment but will still need to be monitored by their treating doctor.

For children who develop more serious bleeding, there are treatment options available to increase their platelet numbers which will help stop bleeding. The main treatment options include corticosteroids (such as prednisone) and intravenous immunoglobulin (IVIG, Intragam).

Care at home

Medication

Certain medications can interfere with how platelets work and should be avoided while the platelet count is low. These include:

  • aspirin
  • non-steroidal anti-inflammatory medications (NSAIDs), such as ibuprofen (Nurofen).

Some over the counter medications and herbal supplements or remedies also contain compounds which can stop platelets working correctly. Please seek medical advice before giving any of these substances to your child.

In a small number of children, the platelet count does not return to normal after 12 months. This is known as chronic ITP and may require further investigation.  Many children with chronic ITP will still recover a normal platelet count over time and may not require specific therapy.

Sport

Children with ITP should be able to participate in most activities and attend school. They will need to avoid

activities that pose a risk of serious bleeding or head injury, such as:

  • climbing playground equipment and trees
  • contact sports such as rugby, AFL and martial arts.

These activities need to be avoided until the platelet count improves and can be discussed with your treating doctor. If your child has a small cut or graze, apply normal first aid measures such as pressure and a band aid to stop the bleeding. This may take longer than usual.

When to seek help

Take your child to your nearest emergency department if they experience any of the following symptoms:

  • head injury
  • persistent or severe headache
  • vomiting or drowsiness
  • prolonged bleeding from mouth, gums or throat
  • blood in the stool or urine
  • coughing up blood
  • nosebleed lasting more than 15 minutes and not improving with pinching the front of the nose and putting the head forward.

If you're not sure whether to go to an emergency department, call 13 HEALTH (13 43 25 84) and speak to a registered nurse.

Resource ID: FS274. Reviewed:  March 2023.  Developed by the General Paediatrics Department, Queensland Children's Hospital.

Disclaimer: This information has been produced by healthcare professionals as a guideline only and is intended to support, not replace, discussion with your child’s doctor or healthcare professionals. Information is updated regularly, so please check you are referring to the most recent version. Seek medical advice, as appropriate, for concerns regarding your child’s health.

Last updated: December 2023