- Article
- Source: Campus Sanofi
- Aug 7, 2025
Defining ITP
The complex immune dysregulation of ITP can impact platelet counts, bleeding, and HRQoL.1,3-6
In ITP, dysregulation of immune pathways results in increased platelet destruction and decreased platelet production.7
Bleeding occurs in around 60% of patients. Bleeding symptoms vary and can include8:
Petechiae and purpura, usually on the extremities1,9
Heavy menstrual bleeding1
Bleeding blisters and epistaxis1,9
Intracranial haemorrhage8
Severe bleeding occurs in 7% to 10% of adult patients and is typically correlated with lower platelet counts.10,11
Some ITP patients may experience systemic symptoms, including fatigue, fever, tachycardia, and cognitive effects, such as headaches and memory impairment.1,12-14
Treatment of ITP typically focuses on managing primary symptoms such as petechiae, purpura, and bleeding. However, patients with ITP often experience other symptoms such as fatigue and difficulties with memory and concentration that can profoundly affect their quality of life. That is why it is important to use treatment strategies that help improve HRQoL in ITP patients.1,12-14
Purpura and petechiae in ITP
ITP is an autoimmune blood disorder where easy bruising, petechiae and purpura often appear as common symptoms typically in lower extremities. Petechiae and purpura occur due to bleeding under the skin or mucous membranes.15,16
Petechiae in thrombocytopenia
Petechiae are small, non-blanching red or purple pinpoint lesions, usually less than 2 mm, that appear on the skin and mucous membranes. Petechial rashes result from bleeding into the skin’s dermal layer.15,17
Purpura in thrombocytopenia
Purpura refers to larger areas of cutaneous bleeding, which appear as purple or red patches on the skin that measure greater than 2 mm in size.15,17
In patients with ITP, purpura can appear due to even minor trauma or spontaneously due to low platelet levels. Purpura can also appear in mucosal membranes such as the hard palate, nasal septum, or gums, which can lead to bleeding gums.15,16,18
Other ITP bleeding symptoms and complications of thrombocytopenia
A low platelet count can lead to certain types of bleeding symptoms in ITP patients, including nose bleeds (epistaxis), gum bleeds (gingival), mouth blood blisters, blood in urine or stools, and heavy menstrual bleeding.9,19
Platelet levels <10,000/μL could be associated with spontaneous widespread haematomas, and severe bleeding in ITP usually occurs when the platelet count is <10 (x109/L). Severe bleeding can manifest as intracranial haemorrhages, gastrointestinal tract bleeds, and macroscopic haematuria. In some studies, severe bleeding occurred in approximately 7% to 10% of adult patients and typically correlated with lower platelet counts.10-12,16,20,21
ITP and intracranial haemorrhaging (brain bleed)
Intracranial haemorrhaging (ICH) is a rare and serious complication of ITP. The incidence of ICH in ITP patients is 1.54% in all ages.19,20,22,23
ICH symptoms that are a cause for concern include headache, persistent vomiting, altered mental status, and seizures. Risk factors for ICH include extremely low platelet counts of <10,000/μL, head trauma, antiplatelet medication use, and severe bleeding.19,20,22,23
The symptoms of ITP go beyond bleeding
Learn more about the less visible symptoms of ITP and how they impact ITP patients’ quality of life.
Primary ITP is a diagnosis of exclusion7,24,25
- Platelet counts <100,000/μL can indicate ITP
- Platelet counts <50,000/μL can indicate severe thrombocytopenia
But the lack of a specific test means other potential causes of thrombocytopenia must be ruled out7,24,26,27
Causes of secondary ITP include7,24,26,27:
- Chronic lymphocytic leukaemia (CLL)
- Helicobacter pylori infection
- COVID-19 infection
ITP is further classified as either newly diagnosed, persistent, or chronic27:
References
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