Understanding ITP (Immune Thrombocytopenic Purpura) in Children – Causes, Symptoms & Treatment

When parents hear that their child’s platelets have dropped drastically — sometimes below 20,000 — it can be deeply alarming. Many immediately associate it with serious illnesses like cancer or leukemia.
But in a majority of these cases, the real cause is ITP — Immune Thrombocytopenic Purpura, a condition where the child’s immune system itself attacks the platelets.

As a Pediatric Hematologist, I often reassure families that ITP is usually a benign, treatable, and often temporary condition — but one that must be carefully monitored and managed.

The exact cause isn’t always clear, but several triggers have been identified:

✅ Viral Infections:
Often develops 1–3 weeks after common viral infections like measles, mumps, chickenpox, or even a simple cold.

✅ Post-Vaccination Response:
In rare cases, certain vaccines can temporarily trigger ITP-like reactions.

✅ Autoimmune Tendency:
In some children, genetic or immune-related predisposition causes the body to target platelets mistakenly.

ITP is not contagious and doesn’t usually mean a child has cancer or a serious bone marrow disease.

Symptoms depend on how low the platelet count is:

• Tiny red or purple spots on the skin (petechiae)
• Larger purplish bruises (purpura) without trauma
• Frequent nosebleeds or bleeding gums
• Prolonged bleeding from small cuts
• Fatigue due to chronic blood loss
• In very severe cases, blood in urine or stool
  

Many children with mild ITP appear completely healthy and active despite low platelet counts.

Diagnosis involves a detailed clinical evaluation and blood tests:

• Complete Blood Count (CBC): Confirms low platelets.
• Peripheral Smear: Ensures other blood cells are normal.
• Bone Marrow Examination (if needed): To rule out leukemia or marrow disorders.
• Autoimmune and Viral Screening: Identifies possible triggers.
  

The goal is to confirm immune-mediated platelet destruction and exclude other serious causes.

Treatment depends on the severity of bleeding rather than the exact platelet count.

✅ Observation Only:

• Many cases (especially after viral infections) resolve spontaneously.
• If the child is active and bleeding is minimal, only close monitoring is required.

✅ Medications:

• Steroids: Help suppress immune destruction of platelets.
• IVIG (Intravenous Immunoglobulin): Rapidly boosts platelet count in moderate to severe cases.
• Anti-D Immunoglobulin: Used selectively in specific cases.

✅ Second-Line Treatments (for chronic ITP):

• Rituximab or thrombopoietin receptor agonists may be used if the condition persists beyond 6–12 months.

✅ Rarely Surgery (Splenectomy):

Considered in resistant, chronic ITP cases — very uncommon in children.

• 80–90% of children recover fully within 6 months.
• Some develop chronic ITP, but even then, platelet counts are often stable enough to lead a normal life.
• Regular follow-ups with a pediatric hematologist are crucial to monitor platelet trends and adjust treatment.

• ITP is usually temporary and treatable.
• Children can attend school and live normally with precautions (avoid contact sports until platelets stabilize).
• Always report new bruises or bleeding to the doctor immediately.
• Never self-medicate or give unprescribed drugs like aspirin, which can worsen bleeding.
  

A diagnosis of ITP may sound frightening, but in most cases, it’s a self-limiting and fully manageable condition.
With timely diagnosis, expert care, and regular monitoring, children recover beautifully — regaining normal platelet levels and full vitality.

If your child has been diagnosed with ITP or a persistently low platelet count, consult a Pediatric Hemato-Oncologist for accurate guidance and personalized care.