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# Immune thrombocytopenia (ITP)

ITP is an autoimmune disease in which antibodies destroy platelets, causing easy bruising and pinpoint bleeding under the [skin](https://durgical.com/en/anatomy/skin/).

Updated 2026-11-01

## Structures involved

Tap one to see what it is and open it in 3D.

- [Spleen](https://durgical.com/en/anatomy/spleen/)
- [Skin](https://durgical.com/en/anatomy/skin/)
- [Gums (gingiva)](https://durgical.com/en/anatomy/gums/)
- [Splenic artery](https://durgical.com/en/anatomy/splenic-artery/)
- [Splenic vein](https://durgical.com/en/anatomy/splenic-vein/)

## In the clinical exam

- [Bleeding syndromes: platelet vs coagulation pattern](https://durgical.com/en/clinical-exam/bleeding-syndromes-platelet-vs-coagulation-pattern/)

## Why it happens

- [Hemorrhage: petechiae, purpura, ecchymosis, hematoma, and what blood loss does](https://durgical.com/en/general-pathology/hemorrhage-petechiae-purpura-ecchymosis-hematoma-and-what-blood-loss-does/)
- [Primary hemostasis and platelets](https://durgical.com/en/physiology/primary-hemostasis-and-platelets/)
- [Innate and adaptive immunity: overview](https://durgical.com/en/physiology/innate-and-adaptive-immunity-overview/)
- [Lymph node and spleen under the microscope](https://durgical.com/en/histology/lymph-node-and-spleen-under-the-microscope/)

## What it is

An acquired autoimmune disorder with an isolated low platelet count (below 100,000/µL) caused by antibody-mediated platelet destruction and reduced platelet production, after other causes have been excluded. It ranges from a self-limited illness in children to a chronic disease in adults.

## Who gets it

In children it often follows a viral infection or vaccination and usually resolves within months. In adults it is more often chronic and more common in women of childbearing age, with a second rise in older people. In the tropics, including Colombia, dengue is a frequent cause of acute thrombocytopenia that must be distinguished from ITP.

## Causes

- Primary: autoantibodies against platelet glycoproteins (mainly GPIIb/IIIa) with no other cause
- Secondary to infection: HIV, hepatitis C, Helicobacter pylori, recent viral illness
- Secondary to autoimmune disease: systemic lupus erythematosus, antiphospholipid syndrome
- Secondary to lymphoproliferative disease such as chronic lymphocytic leukaemia
- Some drugs (drug-induced immune thrombocytopenia is classified separately)

## Risk factors

- Recent viral infection in children
- Female sex in young and middle-aged adults
- Other autoimmune diseases
- HIV, hepatitis C and H. pylori infection

## Pathophysiology

IgG autoantibodies coat platelets, which are then removed by macrophages, mainly in the [spleen](https://durgical.com/en/anatomy/spleen/). Cytotoxic T cells also attack platelets, and antibodies impair megakaryocytes, so production does not rise enough to compensate. The marrow shows normal or increased megakaryocytes, and the spleen is not enlarged.

## Classification

- Newly diagnosed: up to 3 months
- Persistent: 3 to 12 months
- Chronic: more than 12 months
- Primary or secondary

## Symptoms and signs

- Often no symptoms; found on a routine blood count
- Petechiae and purpura, especially on the legs
- Easy bruising
- Gum bleeding, nosebleeds and blood blisters in the mouth (wet purpura)
- Heavy menstrual bleeding
- Normal-sized spleen and otherwise well appearance

## Red flags

- Headache, vomiting or neurological signs (intracranial haemorrhage)
- Wet purpura or active mucosal bleeding
- Gastrointestinal bleeding or blood in the urine
- Fever, weight loss, enlarged spleen or other abnormal blood counts, which suggest another diagnosis such as leukaemia

## Diagnosis

**Clinical**
A diagnosis of exclusion: a well person with mucocutaneous bleeding, no splenomegaly or lymphadenopathy, and no drug or illness that explains the low platelets.

**Tests**
Complete blood count with isolated thrombocytopenia and a peripheral smear (to exclude clumping, schistocytes and blasts; platelets may be large). Testing for HIV, hepatitis C and often H. pylori; in selected cases antinuclear antibodies, thyroid tests and immunoglobulins. Bone marrow examination is reserved for atypical features, age over 60 or failure to respond.

**Imaging**
Not needed routinely; ultrasound if splenomegaly or [liver](https://durgical.com/en/anatomy/liver/) disease is suspected. Head CT if intracranial bleeding is suspected.

## Differential diagnosis

- Pseudothrombocytopenia from platelet clumping in the tube
- Dengue and other viral infections
- Acute leukaemia, aplastic anaemia and myelodysplasia
- Thrombotic thrombocytopenic purpura, haemolytic uraemic syndrome and DIC
- Drug-induced and heparin-induced thrombocytopenia
- Hypersplenism in cirrhosis; gestational thrombocytopenia in pregnancy

## Goal of treatment

Prevent serious bleeding rather than normalise the platelet count; treatment is based on bleeding and risk, not on the number alone.

## Treatment

**Follow-up**
Observation without drug treatment for most children and for adults with mild thrombocytopenia and no significant bleeding.

**Medical**
Corticosteroids are first line when treatment is needed; intravenous immunoglobulin (or anti-D in selected Rh-positive patients) when a rapid rise is required.

**Medical**
Second line for persistent or chronic disease: thrombopoietin receptor agonists, rituximab and other immunosuppressants; H. pylori eradication when the infection is present.

**Surgical**
Splenectomy for selected adults with chronic ITP who do not respond, with vaccination against encapsulated bacteria beforehand.

**Acute**
Life-threatening bleeding: platelet transfusion together with intravenous immunoglobulin and high-intensity corticosteroids.

**Lifestyle**
Bleeding precautions: avoid aspirin and NSAIDs, contact sports and intramuscular injections; use a soft toothbrush.

## Drugs for this condition

- [Romiplostim](https://durgical.com/en/pharmacology/romiplostim/)
- [Eltrombopag](https://durgical.com/en/pharmacology/eltrombopag/)

## Complications

- Intracranial haemorrhage (rare but the most feared)
- Gastrointestinal or heavy menstrual bleeding
- Adverse effects of long-term corticosteroids
- Overwhelming infection after splenectomy
- Neonatal thrombocytopenia in babies of mothers with ITP

## Prognosis

Most children recover spontaneously within 6 to 12 months. In adults the disease is chronic in most cases, but serious bleeding is uncommon and most patients live normally with or without treatment.

## Test yourself

Think of the answer, then tap the question to see it.

## What is the typical presentation of ITP in a child?

A well child with sudden petechiae and bruising a few weeks after a viral infection, with isolated thrombocytopenia and no splenomegaly.

## Against which platelet antigen are ITP autoantibodies most often directed?

Glycoprotein IIb/IIIa.

## What is the usual first-line drug treatment of ITP that needs therapy?

Corticosteroids, with intravenous immunoglobulin when a rapid platelet rise is needed.

## Which drugs should be avoided in a patient with ITP?

Aspirin and NSAIDs, because they further impair platelet function and raise bleeding risk.

## Which finding argues against ITP and calls for more testing?

Splenomegaly, lymphadenopathy, fever or abnormalities in other cell lines, such as anaemia with blasts.

[Add to my cards (5)](https://durgical.app/estudiar/?add=/en/conditions/immune-thrombocytopenia/)

## Related conditions

- [Systemic lupus erythematosus](https://durgical.com/en/conditions/systemic-lupus-erythematosus/)
- [HIV infection and AIDS](https://durgical.com/en/conditions/hiv-infection-and-aids/)
- [Helicobacter pylori gastritis](https://durgical.com/en/conditions/helicobacter-pylori-gastritis/)
- [Dengue](https://durgical.com/en/conditions/dengue/)
- [Disseminated intravascular coagulation](https://durgical.com/en/conditions/disseminated-intravascular-coagulation/)
- [Acute leukaemia (AML and ALL)](https://durgical.com/en/conditions/acute-leukaemia/)
- [Intracerebral haemorrhage](https://durgical.com/en/conditions/intracerebral-haemorrhage/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Immune thrombocytopenic purpura (ITP)](https://medlineplus.gov/ency/article/000535.htm) (MedlinePlus (U.S. National Library of Medicine), 2026).

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Source: https://durgical.com/en/conditions/immune-thrombocytopenia/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/immune-thrombocytopenia/