Immune Thrombocytopenic Purpura (ITP)

Paediatric Emergency Department

Information for parents and carers

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Immune Thrombocytopenic Purpura (ITP)

What is Immune Thrombocytopenic Purpura (ITP)?

ITP is a significant reduction in the blood cells, known as platelets, circulating in the blood stream. It happens in 4 in 100,000 children each year.

What are platelets for?

They are needed to help stop bleeding particularly from nose, gum and mouth bleeds, cuts and grazes.

What can happen if there are not enough platelets?

• Small pin prick spots (petechiae) may develop anywhere on the skin, they may first be noticed at skin creases such as elbows, under the arms, back of the knees or where clothes rub on the skin.
• Impressive bruises may develop from even minor bumps and knocks, the injury itself may not be remembered
• Nose bleeds may be heavy and last a long time
• There may be “blood spots” in the mouth which if knocked when eating or feeding from a bottle can bleed
• Cleaning teeth may cause bleeding
• Knocks on the forehead can cause a large lump to develop

What is Global Developmental Delay (GDD)?

GDD is diagnosed when a child is not meeting some of the expected developmental milestones for their age in two or more areas of their development.
Developmental milestones are different skills that a child usually achieves by a certain age
The four broad areas of development are

• physical abilities such as crawling, walking, and running (gross motor)
• use of their hands (fine motor)
• ability to understand and express themselves (communication)
• Play and interaction with others (social skills)

Why does ITP happen?

There is not always a known cause for platelets to stop circulating. Most commonly it is caused by the body’s immune system working in overdrive, attacking it’s own platelets and removing them from the bloodstream (autoimmune). When trying to fight off and recover from a viral infection the immune system can also damage the platelet factory cells in the bone marrow. The viral infection may hardly have been noticeable and may have occurred as long ago as 6 to 8 weeks before the symptoms of ITP become obvious. ITP can follow from vaccinations which may prime the immune system to be more active

Advice about activities

• When the platelet count is extremely low there will be occasions where involvement in sporting activities will be strongly advised against.
• Children with ITP do not bleed any more quickly than others but they are slower to stop.
• Children with ITP (acute & chronic) should be encouraged to participate in all school activities and trips but should avoid contact sports such as rugby and contact type martial arts

Acute ITP: Most episodes of ITP are quite short lived with full recovery within two or three months. Some cases resolve quite quickly but when another infection is caught the same symptoms come back.
Chronic ITP: A few children go on to develop chronic ITP, this means that the symptoms last for six months or longer. At this stage treatment options may be looked at and further investigations taken.

What will happen next?

A blood test (FBC) to look at the number of platelets and other blood cells under the microscope will be taken. This is to check that the diagnosis is correct and exclude other causes of low platelets. This blood test will be repeated over the next few months to check the platelet levels.

You will be referred to the Paediatric Rapid Access Clinic (PRAC) and they will aim for your child to be seen within 10-14 days.

If you have not received an appointment, you can contact PRAC (see below).

Symptoms and Advice

Bleeding from nose and mouth: Apply pressure and, where possible cold to the affected area and sit quietly. Sucking on ice pops can be helpful. If there is no reduction in the flow of blood after approximately 15- 20 minutes, or you are concerned, seek advice from the Paediatric Emergency Department (PED).
Cuts and grazes: Apply pressure and, where possible, cold to the affected area and sit quietly. If bleeding continues or there is marked swelling and pain seek advice from the PED.
Head injuries: Apply a cold pack and sit quietly. If there is loss of consciousness, persistent or severe headache, vomiting or visual disturbances, attend the PED urgently. Tell the triage nurse that your child has low platelets.
Bleeding: If there is blood in your child’s urine or stools you should seek advice from the PED.
Severe headaches, vomiting or unusual movements: If your child develops any of these symptoms you should seek advice from the PED and if worried that your child is very drowsy or irritable call 999.

Contact Numbers

Useful Websites

itpsupport.org.uk Information and support for children and their parents with a diagnosis of ITP.

There is a UK ITP Registry which you may be asked to participate in to help us understand more about why ITP occurs

This leaflet only gives general information. You must always discuss the individual treatment of your child with the appropriate member of staff. Do not rely on this leaflet alone for information about your child’s treatment.
This information can be made available in other languages and formats if requested.

This information can be made available in other languages and formats if requested.

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