ITP in Children

What is ITP?

ITP
stands for immune thrombocytopenia — a decreased platelet number.

You
may also hear the term "idiopathic" thrombocytopenic purpura which
was the older (historic) name for ITP. "Idiopathic" means the cause
of the low platelets is unknown, but now we know that ITP is caused by problems
in a person's immune system.

ITP
occurs when a person makes antiplatelet antibodies which attach to his/her own
platelets. The antibodies cause the immune system to destroy the platelets.
This results in a decrease in the platelet count.

What are platelets?

Platelets
are the blood cells that help form clots to stop bleeding.

A
blood test is done to count the number of platelets you have.

A
normal platelet count is higher than 100-150,000.

Hematologists
generally agree that platelet counts:

higher
than 100,000 are always safe,

higher
than 30,000 are nearly always safe, and

lower
than 10,000 may be associated with an increased risk of bleeding.

How do you get ITP?

The
cause of ITP is not known. ITP
has been associated with:

recent
viral infection

some
medications

immune
disorders (including Lupus)

infections

There
is nothing you did to cause ITP.

ITP is not contagious.

There
is no cure for ITP. Fortunately, most childhood cases resolve on their own.

Medicines that suppress the immune system, such as 6-mercaptopurine, mycophenolate or sirolimus

Rituximab infusions

Medicines that help the body to make more platelets: romiplostim or eltrombopag

These medications either trick the body's response so that
it does not destroy the platelets or help the body to make more platelets. Physicians may also suggest other drug
therapies that show promise for ITP.

In
some instances a splenectomy (removal of the spleen) may be recommended.

How long does it take to
treat ITP?

Platelet
counts may go up and down for many months.

Childhood
ITP usually resolves itself within 12 months.

Some
patients do not resolve within this period of time and continue with Chronic
ITP.

The chance of the ITP resolving is higher if a patient is younger at diagnosis and in patients with primary ITP (i.e, those without other autoimmune diagnoses or immunodeficiencies).

The likelihood of ITP resolving is the same whether patients have been observed without treatment or have received treatment.

Playing sports is an important part of having fun and living
your life. Having ITP should interfere as little as possible. Just keep in mind
smart play such as wearing helmets, elbow pads, wrist guards and knee pads or
any other protective equipment that is recommended for the sports you wish to
play and try to avoid injury.

What
sports can I play with ITP?
The following is a list of sports you can play or should avoid based on your
platelet count. Just remember to have fun and be safe.DISCLAIMER: There are no formal national guidelines for sports and
activities with ITP. We've modeled these suggestions on those used by the
National Hemophilia Foundation for other types of bleeding disorders.

Sports and outdoor activities can be pretty easily
divided into three groups.

Sports that are safe for
anyone, even with a bleeding disease. Walking, swimming, tennis are examples.

Everything else: basketball, soccer,
baseball are examples.

Sports that are potentially
dangerous for anyone, even without a bleeding disease. Hang gliding, tackle
football, ski racing, wrestling are examples. For many patients, an important
choice is whether it would be better to avoid some riskier contact sports, or
to be treated to raise the platelet count in order to play. This question
doesn't have a single best answer. It is important to consider this choice with
your hematologist. The answer for one child may be quite different from the
next. Always check with your hematologist if your platelet count is on the low
end of any of these parameters for any serious sports playing. Normal platelet
counts are >150,000/mm3. As long as your platelet count is over 75,000, it
is usually safe to play most sports, just be sure to protect yourself as any
athlete would.

If your platelet count
falls below 75,000, it is best if you do NOT...

play
ice hockey with checking, field hockey (because of the sticks), or street
hockey

box

dive
competitively

hang-glide

play
tackle football

play
rugby

play
lacrosse

ride a
motorcycle

play
racquetball (because of potential eye injury from racquets in close quarters)

rock climb

wrestle

If your platelet count is
less than 75,000 but greater than 30,000 to 50,000, it is usually okay to...

play
baseball (just not catcher; wear a helmet on the bases)

play
basketball

bowl

dive
in the pool (just no high dives or competitions)

practice
gymnastics

horseback ride

ice
skate (wear a helmet if you're unsteady!)

practice
karate, Kung Fu or Tae Kwon Do (no kicks to the head!)

mountain bike (wearing a helmet of course)

go
river rafting

roller blade or roller skate (with protective equipment)

run

row

skateboard (with protective equipment)

cross country or downhill ski or snowboard (be sure to wear a helmet) Ski
racing demands a higher platelet count.

The information on this website, including linked resources, should not be taken as medical advice, which can only be given to you by your personal health care professional. Specific treatment plans for any patient with ITP should be arranged after consultation with a physician experienced in this disorder for any given age group.

By its nature, the web has two kinds of bias in medical issues.

First, the web tends to have a bias of reports toward more severe cases because mild cases are under-represented: satisfied families whose child had a mild bout of self-limited illness are unlikely to post their stories on the internet.

Second, the web is more likely to have highly opinionated sources rather than balanced opinions. We hope that our site and the other sites listed here try to avoid these common problems.

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