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Anti-platelet antibodies, usually directed at GPIIb/IIIa or GPIb/IX on the platelet surface
These antibodies flag platelets for destruction by the spleen
Immune thrombocytopenia (ITP) is an autoimmune disorder where the immune system mistakenly attacks and destroys platelets, which are blood cells that help with clotting. This leads to an abnormally low platelet count, increasing the risk of bruising and bleeding—even from minor injuries.
ITP can be acute (short-term) or chronic (lasting more than 6 months) and may occur on its own or alongside other autoimmune diseases.
Symptoms vary depending on how low the platelet count is. Some people have no symptoms, while others experience:
Easy bruising
Petechiae – tiny red or purple spots on the skin
Frequent nosebleeds
Bleeding gums
Heavy menstrual periods
Prolonged bleeding from cuts
Blood in urine or stool
Fatigue
In rare, severe cases, internal bleeding or brain hemorrhage can occur.
The exact cause isn’t always known, but ITP happens when the immune system:
Produces autoantibodies that attack platelets
Sometimes targets the cells in the bone marrow that produce platelets
Possible triggers include:
Viral infections – especially in children (e.g., Epstein-Barr, hepatitis, HIV, or after COVID-19)
Vaccinations – rarely, especially in children, after MMR
Autoimmune diseases – like lupus or antiphospholipid syndrome
Certain medications
Pregnancy
Cancers – like lymphomas (rarely)
ITP in children often follows a viral illness and resolves on its own. In adults, it is more likely to be chronic.
There’s no single test for ITP. It’s usually a diagnosis of exclusion, meaning other causes of low platelets must be ruled out.
Tests include:
Complete blood count (CBC) – shows low platelets with otherwise normal blood cells
Blood smear – to rule out other blood disorders
Bone marrow biopsy – in rare cases, especially in older adults or when diagnosis is unclear
Tests for infections or autoimmune markers – to find possible underlying causes
Treatment depends on the platelet count and bleeding symptoms.
Observation only – for mild cases with no bleeding
Corticosteroids (prednisone) – first-line treatment to suppress the immune attack
IVIG (intravenous immunoglobulin) – for rapid platelet boost, especially in emergencies
Rituximab – a biologic that targets immune B cells
Thrombopoietin receptor agonists – like eltrombopag or romiplostim to stimulate platelet production
Splenectomy – removal of the spleen, considered in chronic, treatment-resistant cases
In children, most cases resolve within weeks to months.
In adults, ITP is often chronic but manageable.
Severe complications (like brain bleeding) are rare, especially with proper treatment.
Affects 3–4 per 100,000 adults per year
More common in women under 60
Higher risk in those with other autoimmune diseases
Neunert C, et al. The American Society of Hematology 2019 guidelines for immune thrombocytopenia. Blood Adv. 2019;3(23):3829-3866.
Provan D, et al. Updated international consensus report on the investigation and management of primary immune thrombocytopenia. Blood Adv. 2019;3(22):3780–3817.
Zufferey A, et al. Pathogenesis and therapeutic mechanisms in immune thrombocytopenia. J Clin Med. 2021;10(3):789.
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