ITP (immune thrombocytopenia) is a disease in which the body's immune system mistakenly destroys blood platelets and also reduces how many are made; the platelet count falls below 100,000, while the other blood cells are usually normal [1, 4]. ITP is an autoimmune disease, not cancer: in children, about 8 in 10 get better within a few weeks to a few months [4], and adults whose platelet count is 30,000 or more and who are not bleeding are usually just monitored [2]. If treatment is needed, it usually starts with a short course of a steroid medicine, and there are other effective medicines too [1].
Key points
- In ITP, the immune system destroys the body's own platelets; the platelet count is below 100,000 and the rest of the blood count is usually normal [1, 4].
- ITP is uncommon: each year about 1 to 6 in every 100,000 adults and about 2 to 6 in every 100,000 children develop it [1, 4]. ITP is an autoimmune disease, not cancer.
- In children it usually starts suddenly, often after an infection, and about 8 in 10 children get better within a few weeks to a few months; in adults it tends to last longer [4, 6].
- The aim of treatment is a safe platelet count, not a normal one [3]. An adult whose platelet count is 30,000 or more and who is not bleeding is usually just monitored [2].
- Do not take aspirin, ibuprofen or similar painkillers without asking your doctor; these medicines increase the risk of bleeding [3, 4].
- Bleeding that will not stop, blood in the urine or stools, or a sudden severe headache is an emergency [10].
What is ITP?
Platelets are very small cells in the blood that help bleeding stop. In ITP (immune thrombocytopenia), the immune system mistakenly destroys the body's own platelets and also reduces how many the bone marrow makes [1]. In this disease the platelet count is below 100,000 per microlitre, while the red and white blood cells are usually normal [4].
ITP sometimes occurs on its own (primary ITP) and sometimes together with another condition (secondary ITP), for example infection with HIV or hepatitis C, or an autoimmune disease such as lupus [1, 3]. ITP is an autoimmune disease, not cancer. It can happen at any age, but it is more common in childhood and in older age [1].
How is ITP different in children and adults?
- Children: the disease usually starts suddenly with tiny red spots on the skin, and often the child had an infection about two weeks earlier [4]. About 8 in 10 children, with or without treatment, recover completely within a few weeks to a few months [4].
- Adults: the disease tends to last longer. In a French study, about 6 in 10 adults still had ITP a year later [6]. When ITP lasts more than a year, it is called "chronic ITP" [4]. Even then, the aim of treatment is for the person to be able to carry on with their usual activities [3].
Symptoms
About half of adults have no signs of bleeding when they are diagnosed, and ITP is found on a routine blood test [6]. Common symptoms [3, 10]:
- Bruising easily or for no reason
- Tiny red or purple spots on the skin (petechiae)
- Nosebleeds or bleeding gums
- Heavier periods than usual
- Tiredness, which can itself be part of ITP
How severe the symptoms are does not always match the platelet count [1]. Serious bleeding is uncommon: in studies, bleeding in the brain was seen in about 1 in 70 adults and 1 in 250 children with ITP, mostly in people who had had ITP for a long time [5].
The risk of serious bleeding is higher when [3, 4]:
- The platelet count is below 20,000, especially below 10,000
- There are blood blisters inside the mouth, blood in the urine, long nosebleeds or bleeding from the gut
- There has been an injury
- The person takes aspirin, ibuprofen, similar painkillers or blood thinners
Which tests?
There is no simple specific test for ITP; it is diagnosed by ruling out the other causes of a low platelet count [3, 4]. The doctor usually does the following [3]:
- Full blood count (CBC): in ITP, usually only the platelet count is low. To read your results, see Understanding your CBC results.
- Looking at the blood under a microscope (blood film): this shows that the platelets have not simply clumped together in the test tube and that there is no sign of another disease.
- Further tests: such as tests for HIV and hepatitis B and C, immunoglobulin levels and blood group. Where the stomach bacterium Helicobacter pylori is common, a breath or stool test for it is also done. Treating HIV or hepatitis C infection sometimes brings the platelet count fully back to normal.
- Bone marrow sample: not needed in typical ITP; it is done when there is an unusual finding, when the first treatment does not work, when the disease comes back after recovery or when surgery to remove the spleen is being considered.
If, together with a low platelet count, you have anaemia or an abnormal white cell count, fever, weight loss, or an enlarged spleen, liver or lymph nodes, the doctor looks for other causes, including diseases of the bone marrow and lymph nodes such as lymphoma [3]. Read about the other causes of a low platelet count in Low or high platelet count: what does it mean?
For physicians
| Topic | Guidance |
|---|---|
| Definition | Platelets below 100 × 10⁹/L with isolated thrombocytopenia (IWG definition); the former cut-off of 150 × 10⁹/L was abandoned because some non-white populations have lower platelet counts without any bleeding risk [4] |
| Phases | Newly diagnosed up to 3 months, persistent more than 3 to 12 months, chronic more than 12 months; primary or secondary ITP [3, 4] |
| Response | Complete: platelets at least 100 × 10⁹/L and resolution of bleeding; response: platelets 30 to 100 × 10⁹/L with at least doubling and no clinically relevant bleeding; no response: below 30 × 10⁹/L, less than doubling or continued clinically relevant bleeding [4] |
| Basic assessment | Diagnosis by exclusion of other causes of isolated thrombocytopenia: history, examination, CBC and reticulocyte count, expert review of the peripheral blood film by a haematologist or pathologist (to exclude EDTA-dependent pseudothrombocytopenia, schistocytes, leucocyte inclusions, giant or small platelets); Rh(D) blood group; IgG, IgA and IgM levels [3] |
| Viral and H. pylori testing | HIV, HCV and HBV in adults, before blood products and IVIG; H. pylori urea breath test or stool antigen test in adults with typical ITP, digestive symptoms or from high-prevalence areas (serology may be falsely positive after IVIG) [3] |
| DAT | Positive in about 20% of patients with ITP; if positive: haptoglobin, LDH, bilirubin and reticulocytes to assess haemolysis; particularly when anaemia comes with a raised reticulocyte count or anti-D treatment is being considered; Rh(D) typing is essential before anti-D [3] |
| Bone marrow | Not needed initially in isolated thrombocytopenia with a normal examination and blood film; indicated in relapse after remission, no response to initial treatment, before splenectomy or with unusual findings; should include aspirate, biopsy, flow cytometry and cytogenetics; increased reticulin in about one-third of patients does not correlate with disease severity [3] |
| Warning findings | Moderate or massive splenomegaly, fever, weight loss, hepatomegaly or lymphadenopathy point to another cause (HIV, liver disease, SLE or a lymphoproliferative disorder) [3]; a platelet rise after corticosteroids or IVIG increases confidence in the diagnosis of ITP [1] |
Treatment
Treatment regimens and doses: index10 regimens
Why do many people not need medicine?
The aim of ITP treatment is a platelet count high enough to prevent serious bleeding; the count does not need to become normal [3]. So:
- An adult who has just been diagnosed, whose platelet count is 30,000 or more and who has no bleeding, or only bruising and minor bleeding from the skin and mucous membranes, is usually monitored without medicine [2].
- A child with no bleeding, or only bruising and tiny spots on the skin, is usually monitored without medicine and without a hospital stay [2].
When is treatment needed?
The doctor usually starts treatment when [2, 3]:
- An adult's platelet count is below 30,000
- There is bleeding
- Surgery or another medical procedure with a risk of bleeding is planned
- The person takes a blood thinner or an antiplatelet medicine, has another illness that raises the risk of bleeding, or is over 60
- The person's work or lifestyle carries a risk of injury, or tiredness is disrupting their life
What does treatment usually involve?
- 1
A short course of a steroid medicine
The first treatment is usually steroid tablets (prednisolone) or a few days of high-dose dexamethasone. The whole course should preferably last no more than 6 weeks, to reduce side effects [1, 2]. The latest American Society of Hematology guideline suggests that, in adults, rituximab or one of the medicines that boost platelet production be given alongside the steroid from the start, because this makes it more likely that the platelet count stays good after treatment stops [1].
- 2
When the platelet count must rise quickly
If there is serious bleeding or the platelet count needs to rise quickly, intravenous immunoglobulin (IVIG) is used; in severe bleeding it is given together with intravenous steroids and sometimes a platelet transfusion [3]. For some people with Rh-positive blood whose spleen has not been removed, an injection of "anti-D immunoglobulin" is another option [3, 16].
- 3
If the disease continues or comes back
There are two main options [1]: medicines that boost platelet production, such as eltrombopag or avatrombopag tablets or weekly romiplostim injections under the skin; and rituximab, which is usually given as 4 drips, one a week, and suits people who do not want to take a medicine for a long time. Medicines that boost platelet production are usually taken for a long time, but in some people the platelet count stays good even after the medicine is stopped [1]. If these medicines are not suitable, there are others such as mycophenolate, fostamatinib or rilzabrutinib [1].
- 4
Removing the spleen
An operation to remove the spleen is considered for people who have not been helped by several medicines or who do not want to take medicines for a long time [1]. Because ITP can get better on its own, this operation is preferably done at least a year after diagnosis, and the necessary vaccines are given at least two weeks beforehand [1]. After the spleen is removed, the risk of serious infection is higher for life; so take every fever seriously and tell a doctor straight away [1].
For physicians
Treatment thresholds in adults (ASH 2019; not updated in ASH 2026). Newly diagnosed adults who are asymptomatic or have minor mucocutaneous bleeding: with platelets below 30 × 109/L, corticosteroids rather than observation (conditional recommendation, very low certainty), and with 30 × 109/L or more, observation rather than corticosteroids (strong recommendation, very low certainty); at the lower end of this range, with comorbidities, anticoagulant or antiplatelet medication, an upcoming procedure or age over 60, corticosteroids may be appropriate. Newly diagnosed patients with platelets below 20 × 109/L: admission is suggested; established ITP with the same count: outpatient management (both conditional) [1, 2]. ICR 2019: treatment is rarely indicated with platelets above 20 × 109/L unless there is bleeding due to another haemostatic defect, trauma, surgery, a comorbidity predisposing to bleeding, mandated anticoagulant or antiplatelet therapy, fatigue, or a profession or lifestyle that predisposes to trauma; the target is a platelet count above 20 to 30 × 109/L at least in symptomatic patients, with no need to normalise the count; this level may not be enough for patients who are active, older than 60, have comorbidities or take anticoagulants [3].
Initial therapy (ASH 2026, recommendation 1). Adults with primary ITP who need treatment: rituximab plus corticosteroids or a thrombopoietic agent plus corticosteroids (with or without IVIG) rather than corticosteroids alone or MMF plus corticosteroids (conditional recommendation, low certainty). A short course (2 weeks or less) of corticosteroids with or without IVIG before combination therapy is reasonable to increase diagnostic confidence; corticosteroids should in any case be limited to 6 weeks or less; in responders to a thrombopoietic agent plus corticosteroids, taper the corticosteroids first. SRoT at 6 months compared with standard care: thrombopoietic agent 52% vs 33% (OR 2.33; 95% confidence interval 1.48 to 3.37) and anti-CD20 52% vs 32% (OR 2.33; 0.88 to 6.12) [1].
After failure of corticosteroids (ASH 2026, recommendation 2). A thrombopoietic agent (strong recommendation, moderate certainty) or rituximab (conditional recommendation, low certainty); if the patient cannot or will not take either: MMF, a BTK inhibitor or a SYK inhibitor (conditional, very low certainty, not ranked against each other); azathioprine has a less favourable benefit-to-harm ratio but is safe in pregnancy. Thrombopoietic agents in this group: SRoT 30% at 6 months (59 of 195) and 27% at 12 months (43 of 158). Switching to another thrombopoietic agent is reasonable for insufficient response, adverse effects, comorbidities, poor adherence or patient preference, avoiding treatment gaps and with close monitoring. Splenectomy: preferably at least 1 year after diagnosis; immunisation at least 2 weeks before surgery, education on prompt antibiotic treatment of fever, counselling on the lifelong risk of sepsis and thrombosis, and follow-up at least yearly [1].
Life-threatening bleeding (ICR 2019). When the platelet count must rise within 24 hours, combine intravenous corticosteroids and usually IVIG; platelet transfusion must not be postponed in life-threatening bleeding, especially intracranial haemorrhage; a thrombopoietic agent if the response to IVIG is inadequate (response takes at least 5 days; rituximab usually 3 to 4 weeks); vincristine 1 to 2 mg intravenously weekly for 2 to 4 weeks; tranexamic acid 15 to 20 mg/kg orally every 8 hours (efficacy not tested in a randomised trial in ITP; it increases the risk of thrombosis) [3].
Children (ASH 2019). Newly diagnosed with no or minor bleeding: observation rather than corticosteroids (conditional) and rather than IVIG or anti-D (strong, moderate certainty), and outpatient management even with platelets below 20 × 109/L (conditional). Non-life-threatening mucosal bleeding or reduced quality of life: corticosteroid courses of 7 days or less (strong); prednisone 2 to 4 mg/kg/day (maximum 120 mg/day, for 5 to 7 days) rather than dexamethasone 0.6 mg/kg/day (maximum 40 mg/day, for 4 days); anti-D or IVIG are also options [1, 2]. Italian consensus 2024: about 80% of children reach a complete sustained remission within a few weeks to a few months regardless of treatment, and ICH occurs in less than 1%; single-dose IVIG 0.8 to 1 g/kg or prednisone 1 to 2 mg/kg/day for 15 days, methylprednisolone 5 to 10 mg/kg/day intravenously for 3 days or dexamethasone 0.6 mg/kg/day for 4 days; predictors of chronic ITP: female sex, age over 10 years, no preceding infection or vaccination and platelets above 20 × 109/L at diagnosis [4].
Evidence on bleeding and disease course. Systematic review of 118 studies (10,908 patients): ICH 1.4% in adults (95% confidence interval 0.9 to 2.1%) and 0.4% in children (0.2 to 0.7%), mostly in chronic ITP; severe non-ICH bleeding 9.6% in adults and 20.2% in children [5]. CARMEN cohort (113 newly diagnosed adults, median age 65 years, median platelet count 17 × 109/L): secondary ITP 20.3%, bleeding symptoms 50.9%, persistence 68.2% and chronicity 58.7%; positive ANA was associated with chronicity (OR 2.89; 1.08 to 7.74) [6].
Initial and emergency treatment of ITP: doses
Prednisone or prednisolone
Newly diagnosed adult ITP needing treatment; alone or with rituximab or a thrombopoietic agent
Newly diagnosed adult ITP needing treatment; alone or with rituximab or a thrombopoietic agent
| Drug | Dose | Route | Schedule |
|---|---|---|---|
| Prednisone or prednisolone | 0.5 to 2 mg/kg/day (ICR: 1 mg/kg, maximum 80 mg) | Oral | Daily for 2 weeks (maximum 3 weeks), then taper |
ASH 2019: a short course of 6 weeks or less, including treatment and taper, rather than a longer course (strong recommendation), and prednisone 0.5 to 2.0 mg/kg/day or dexamethasone (conditional) [2]. ASH 2026: the same dose is also appropriate for the corticosteroid component of combination therapy [1]. ICR: 1 mg/kg (maximum 80 mg) for 2 weeks and at most 3 weeks, aiming to stop by week 6 (maximum 8) [3].
High-dose dexamethasone
Newly diagnosed adult ITP; preferred when a rapid platelet rise matters
Newly diagnosed adult ITP; preferred when a rapid platelet rise matters
| Drug | Dose | Route | Schedule |
|---|---|---|---|
| Dexamethasone | 40 mg/day | Days 1 to 4 |
ASH 2019: if a rapid response is valued, dexamethasone may be preferred because of the better response at day 7 [2]. ASH 2026: the most studied corticosteroid component of combination therapy is 40 mg daily for 4 days for 1 to 3 cycles 2 to 4 weeks apart [1]. ICR: repeat up to 3 times; aciclovir may be given to reduce the risk of herpes virus reactivation [3].
Intravenous immunoglobulin (IVIG)
Need for a rapid platelet rise or bleeding; in life-threatening bleeding together with intravenous corticosteroids
Need for a rapid platelet rise or bleeding; in life-threatening bleeding together with intravenous corticosteroids
| Drug | Dose | Route | Schedule |
|---|---|---|---|
| Option 1 | |||
| IVIG | 1 g/kg per day | Intravenous | 1 to 2 consecutive days |
| Option 2 | |||
| IVIG | 0.4 g/kg per day | Intravenous | 5 consecutive days |
ICR: 1 g/kg on 1 or 2 consecutive days, or 0.4 g/kg per day for 5 days [3]. GAMUNEX-C label: if the platelet count has risen adequately 24 hours after the first 1 g/kg dose, the second dose may be withheld; the 1 g/kg regimen is not recommended in people with expanded fluid volumes or where fluid volume is a concern; boxed warning for thrombosis, renal dysfunction and acute renal failure; in patients at risk, use the minimum practicable infusion rate [17]. Before IVIG: immunoglobulin levels and viral testing [3].
Intravenous anti-D immunoglobulin (anti-D)
Rh(D)-positive, non-splenectomised patients: children with acute or chronic ITP, adults with chronic ITP, ITP secondary to HIV
Rh(D)-positive, non-splenectomised patients: children with acute or chronic ITP, adults with chronic ITP, ITP secondary to HIV
| Drug | Dose | Route | Schedule |
|---|---|---|---|
| Rho(D) immune globulin intravenous (WinRho SDF) | 50 µg/kg (250 IU/kg) | Intravenous, over 3 to 5 minutes | Single dose |
ICR: 50 to 75 µg/kg once [3]. Label: with haemoglobin below 10 g/dL a reduced dose of 25 to 40 µg/kg, and below 8 g/dL an alternative treatment. Boxed warning for intravascular haemolysis (sometimes fatal; severe anaemia, renal failure, DIC and ARDS): monitor for at least 8 hours in a healthcare setting, with dipstick urinalysis for haematuria and haemoglobinuria at baseline, at 2 and 4 hours and before the end of monitoring [16]. Before treatment: Rh(D) blood group and DAT [3].
Doses follow the trial protocol, guideline or official drug label (source given in the notes of each regimen). Before prescribing, check blood counts, renal and hepatic function, drug interactions and the patient’s condition, and adjust the dose according to the drug label.
After corticosteroids: doses
Eltrombopag
Persistent or chronic ITP in adults and children aged 1 year or older with an insufficient response to corticosteroids, immunoglobulins or splenectomyCycle length: Continuous
Persistent or chronic ITP in adults and children aged 1 year or older with an insufficient response to corticosteroids, immunoglobulins or splenectomy
| Drug | Dose | Route | Schedule |
|---|---|---|---|
| Eltrombopag | 50 mg once a day; 25 mg in patients of East or Southeast Asian ancestry, with hepatic impairment (Child-Pugh A to C) and in children aged 1 to 5 years | Oral | Daily |
Maximum 75 mg a day; take at least 2 hours before or 4 hours after antacids, calcium-rich foods and mineral supplements (polyvalent cations). Boxed warning for the risk of hepatotoxicity: liver tests before and during treatment [11].
Romiplostim
Adults with ITP and an insufficient response to corticosteroids, immunoglobulins or splenectomy; children aged 1 year or older with ITP for at least 6 monthsCycle length: Weekly
Adults with ITP and an insufficient response to corticosteroids, immunoglobulins or splenectomy; children aged 1 year or older with ITP for at least 6 months
| Drug | Dose | Route | Schedule |
|---|---|---|---|
| Romiplostim | Start 1 µg/kg (actual body weight); increase by 1 µg/kg until platelets are 50 × 10⁹/L or more | Subcutaneous | Once a week |
Maximum 10 µg/kg a week; CBC weekly during dose adjustment, then monthly, and weekly for at least 2 weeks after stopping; stop if, after 4 weeks at the maximum dose, the platelet count has not risen enough to avoid clinically important bleeding [12].
Avatrombopag
Adults with chronic ITP (and children aged 1 year or older with persistent or chronic ITP) with an insufficient response to a previous treatmentCycle length: Continuous
Adults with chronic ITP (and children aged 1 year or older with persistent or chronic ITP) with an insufficient response to a previous treatment
| Drug | Dose | Route | Schedule |
|---|---|---|---|
| Avatrombopag | 20 mg once a day | Oral | Daily |
Maximum 40 mg a day; children aged 6 years or older take the same tablets; children aged 1 to under 6 years: 10 mg granules once a day, maximum 20 mg a day [13].
Rituximab
After failure of corticosteroids, or with corticosteroids as initial therapy; especially for patients who want to avoid long-term medication or for whom a thrombopoietic agent is not suitableCycle length: Weekly
After failure of corticosteroids, or with corticosteroids as initial therapy; especially for patients who want to avoid long-term medication or for whom a thrombopoietic agent is not suitable
| Drug | Dose | Route | Schedule |
|---|---|---|---|
| Rituximab | 375 mg/m² | Intravenous | Once a week |
Fostamatinib
Adults with chronic ITP and an insufficient response to a previous treatment (SYK inhibitor)Cycle length: Continuous
Adults with chronic ITP and an insufficient response to a previous treatment (SYK inhibitor)
| Drug | Dose | Route | Schedule |
|---|---|---|---|
| Fostamatinib | 100 mg twice a day; if platelets have not reached 50 × 10⁹/L after 4 weeks, 150 mg twice a day | Oral | Daily |
Adverse reactions are managed by dose reduction, interruption or discontinuation; monitor blood pressure and liver tests according to the dose-modification table in the label [14].
Rilzabrutinib
Adults with persistent or chronic ITP and an insufficient response to a previous treatment (BTK inhibitor)Cycle length: Continuous
Adults with persistent or chronic ITP and an insufficient response to a previous treatment (BTK inhibitor)
| Drug | Dose | Route | Schedule |
|---|---|---|---|
| Rilzabrutinib | 400 mg twice a day | Oral | Daily |
Swallow tablets whole with a glass of water, with or without food (with food if there are gastrointestinal symptoms); risk of serious infections; bilirubin and transaminases at baseline and as needed; before starting, check pregnancy status and advise effective contraception (possible harm to the fetus) [15].
Before prescribing, check each dose against the drug label, laboratory tests and the patient’s condition.
Pregnancy
A fall in the platelet count is common in pregnancy and affects up to 12 in every 100 pregnant women; ITP is only one of its causes [8]. If you have ITP and are pregnant or planning a pregnancy:
- Talk to your doctor before you become pregnant [9]. Some ITP medicines are not suitable in pregnancy (such as mycophenolate), and the safety of others (such as rituximab and the medicines that boost platelet production) in pregnancy is not yet clear [1]. The usual treatments in pregnancy are steroids (prednisone) and intravenous immunoglobulin [9].
- In a large study, serious bleeding was no more common in pregnant women with ITP than in non-pregnant women with ITP; but severe drops in the platelet count and the need to change treatment were more common in pregnancy [7].
- ITP on its own is not a reason for a caesarean section; the type of delivery is decided by obstetric reasons [9]. A platelet count above 50,000 is usually considered enough for a vaginal delivery [9], and with a platelet count of 70,000 or more the risk from a spinal or epidural anaesthetic is very low [8].
- The mother's antibodies can cross the placenta and lower the baby's platelet count too [1]. In the same study, about 1 in 7 babies had a platelet count below 50,000; this was more likely if a previous baby had also had low platelets or if the mother's platelet count was below 50,000 in the last 3 months of pregnancy [7]. This is why the baby's platelet count is checked after birth [9].
For physicians
ITP in pregnancy (for doctors). French prospective cohort (131 pregnant women with ITP vs 131 non-pregnant women with ITP, 15 months of follow-up): the first ITP worsening did not differ (53.4 vs 37.1 per 100 person-years; HR 1.35; 0.89 to 2.03), but recurrence of severe thrombocytopenia (HR 2.71; 1.41 to 5.23) and treatment modification (HR 2.01; 1.14 to 3.57) were more frequent in pregnancy, while recurrence of severe bleeding did not differ; neonatal thrombocytopenia below 50 × 109/L in 14% (19 neonates), associated with a previous affected neonate (aOR 5.55; 1.72 to 17.89) and a maternal platelet count below 50 × 109/L within 3 months before delivery (aOR 4.07; 1.41 to 11.73) [7]. SOAP 2021: the risk of spinal epidural haematoma with platelets of 70 × 109/L or more is likely to be very low in gestational thrombocytopenia, ITP and hypertensive disorders of pregnancy, in the absence of other risk factors [8]. Chinese consensus 2021: late in the third trimester, platelets above 50 × 109/L for vaginal delivery and above 80 × 109/L for caesarean section and spinal/epidural anaesthesia; ITP is not an indication for caesarean section; first line prednisone 10 to 20 mg/day (with caution in the first trimester) and IVIG 400 mg/kg/day for 3 to 5 days or 1000 mg/kg for 1 to 2 days; in the first trimester, consider IVIG; monitor the neonatal platelet count after delivery [9]. ASH 2026: MMF is contraindicated in pregnancy and the safety of rituximab and thrombopoietic agents in pregnancy is not well established; splenectomy does not prevent transplacental passage of maternal antiplatelet antibodies [1].
Everyday life with ITP
- The aim of treatment is that you can carry on with work, study and your usual activities [3].
- Do not take aspirin, ibuprofen or other anti-inflammatory painkillers, or blood thinners, without asking your doctor; these medicines are linked to more bleeding [3, 4]. For pain or fever, ask your doctor or pharmacist which medicine is right for you.
- Before any surgery, tooth extraction or other medical procedure, say that you have ITP; the doctor may raise your platelet count beforehand [3].
- If your work or sport carries a risk of injury (such as martial arts and contact sports), talk to your doctor; injury is a risk factor for serious bleeding, and in this situation the doctor sometimes starts treatment sooner [3, 4].
- When your platelet count is low, use a soft toothbrush and an electric shaver instead of a razor, and cut down on alcohol or stop drinking it [10].
- Tiredness can be part of ITP; if it is disrupting your life, tell your doctor, because it also matters when treatment is decided [3].
- If you have heavy periods, talk to your doctor; in teenagers they are usually controlled with hormonal pills and the medicine tranexamic acid [4].
- Children with ITP are advised to have the usual vaccines of the vaccination schedule [4]; see the section "Frequently asked questions".
When should I see a doctor urgently?
Most people with ITP do not develop serious bleeding [5]. But:
Go to an emergency department straight away or call your local emergency number if [10]:
- You have bleeding that does not stop after a few minutes of pressure
- You vomit blood, your stools are black or bloody, or your urine is red or pink
- You have a severe headache, changes in your vision, confusion or unusual drowsiness, especially after a blow to the head [4]
Contact your doctor the same day if:
Frequently asked questions
Is ITP a blood cancer?
No. ITP is an autoimmune disease in which the immune system destroys platelets [1]. But because some diseases of the bone marrow and lymph nodes can also lower the platelet count, the doctor rules them out with blood tests, a blood film and an examination, and takes a bone marrow sample if there is an unusual finding [3]. Read about blood cancers: Blood cancers.
With ITP, what platelet count is dangerous?
The risk of serious bleeding is mainly when the platelet count is below 20,000 [3], especially below 10,000 [4]. An adult whose platelet count is 30,000 or more and who is not bleeding is usually just monitored [2]. See the general table in What platelet count is dangerous?
Does ITP go away?
In children, usually yes: about 8 in 10 children get better within a few weeks to a few months [4]. In adults the disease tends to last longer, and in one study about 6 in 10 still had ITP a year later [6]; even so, with today's treatments the platelet count of most patients can be kept at a safe level [1].
Can a child with ITP have vaccines?
Yes. The usual childhood vaccines are recommended, even if the child has had a low platelet count before [4]. ITP after the measles, mumps and rubella vaccine is much less common than ITP after the diseases themselves, and in more than 9 in 10 children it clears up completely within 6 months [4]. If a child had a low platelet count within 6 weeks of this vaccine, the doctor decides about the second dose after checking measles antibodies [4].
Can I exercise with ITP?
Can I get pregnant if I have ITP?
Yes; it is important to talk to your doctor before pregnancy so that your medicines and follow-up plan can be decided [1, 9]. In a large study of pregnant women with ITP, serious bleeding was no more common than in non-pregnant women with ITP, although drops in the platelet count and the need to change treatment were more common [7]. See the section "Pregnancy".
Related links
Related blood disorders
Related questions
References
18 referencesShow all referencesClose the reference list
Numbers in the text, such as [1], refer to these sources. Sources with a “Study card” button are summarised in the site’s evidence library.
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- 11PROMACTA (eltrombopag) tablets and oral suspension — Prescribing Information
- 12NPLATE (romiplostim) for injection — Prescribing Information
- 13DOPTELET (avatrombopag) tablets and DOPTELET SPRINKLE oral granules — Prescribing Information
- 14TAVALISSE (fostamatinib disodium hexahydrate) tablets — Prescribing Information
- 15WAYRILZ (rilzabrutinib) tablets — Prescribing Information
- 16
- 17GAMUNEX-C (immune globulin injection [human], 10% caprylate/chromatography purified) — Prescribing Information
- 18RITUXAN (rituximab) injection — Prescribing Information
This page is based on reputable scientific sources and was last updated on 29 October 2026. The content of this website is for educational and informational purposes only and does not replace consultation, diagnosis or treatment by a specialist physician. Consult your treating physician about any treatment decision.
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