What is immune thrombocytopenia?

• Immune thrombocytopenia (previously known as idiopathic thrombocytopenia purpura [ITP]) is a bleeding disorder caused by having too few platelets in the blood. Platelets are small cells in the blood that help form blood clots, which stop bleeding.
• No one knows exactly why ITP occurs, but the immune system begins to attack the body’s own platelets. It may be triggered by the aftereffects of a viral infection. It often goes away on its own. It is not contagious.
• Immune thrombocytopenia must be distinguished from more serious conditions. It is more likely to develop in a child while he or she is in child care or school than to be a preexisting condition.
• Expected course is as follows:
  • Within 6 to 12 months, 80% of children with ITP have a normal platelet count.
  • A few children go on to have more chronic cases.
  • The risk of bleeding may increase because of the low platelet count.

What are some common characteristics of children who have immune thrombocytopenia or of immune thrombocytopenia as children present with it?

• Immune thrombocytopenia can start with purple bruising (purpura) or a characteristic type of pinpoint bleeding on the skin called petechiae.
• Children with ITP commonly present with nosebleeds or oral bleeding.
• The child may also have blood in the urine or stool.
• Because children with ITP present with unexplained bruising, there may be a concern about child abuse before the condition is diagnosed. However, ITP is not caused by physical abuse.
• Children generally appear healthy, despite their bruises, and have no other symptoms. They are often remarkably resistant to bruising, despite very low platelet counts.

Who might be on the treatment team?

• Primary care provider in the medical home
• Pediatric hematologist

What adaptations may be needed?

Medications

• In mild cases, no medications are required.
• Sometimes, ITP is treated with immune therapy or corticosteroids.
  • Immune therapy is usually administered in a health care setting.
  • Corticosteroids can usually be given at home. The side effects of corticosteroids, which include mood changes, increased appetite, nausea, weight gain, and behavior changes, might be seen while the child is in child care or school.
  • Rarely, the spleen must be removed.
• All children with clotting factor disorders should avoid nonsteroidal anti-inflammatory drugs such as ibuprofen (eg, Advil, Motrin), naproxen (eg, Aleve), and aspirin.
• Acetaminophen (eg, Tylenol) is usually fine to use, but patients with bleeding disorders should discuss any medications to be taken with their doctors and health care professionals, even over-the-counter medications.

Dietary Considerations

There is no special diet for children with ITP.

Physical Environment and Other Considerations

• Schedule a visit with parents/guardians before their child returns to the school or program to review specifics of their child’s condition.
• Have the child avoid contact sports and activities that could cause head trauma, and limit climbing. A child with ITP may need to stay home until the condition is under control. Precautions include ensuring that straps in high chairs are fastened and that sharp corners are padded.

What should be considered an emergency?

• Call emergency medical services (911) for
  • Uncontrolled bleeding, including a nosebleed that doesn’t stop after 15 minutes
  • Headache
  • Inability to move a body part
  • Change in behavior
  • Difficulty speaking
  • Loss of consciousness
• Call parents/guardians for
  • Increased bruising
  • Minor bleeding that is controlled with first aid

What types of training or policies are advised?

• First aid to stop bleeding
• Standard injury precautions
• Background about ITP

What are some resources?

• National Heart, Lung, and Blood Institute: www.nhlbi.nih.gov, 301/592-8573—“What is immune thrombocytopenia?,” www.nhlbi.nih.gov/health/health-topics/topics/itp
• National Institutes of Health, US National Library of Medicine: “Idiopathic Thrombocytopenic Purpura (ITP),” https://nlm.nih.gov/medlineplus/ency/article/000535.htm

Source: Managing Chronic Health Needs in Child Care and Schools: A Quick Reference Guide.

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The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

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