Easy Bruising

Bruises develop when blood leaks under the skin after an injury or bump. People with ITP may develop large bruises from ordinary activities or minor injuries. Bruises often appear on the elbows and knees, but they can develop anywhere on the body.

People with ITP may also develop purpura, which are purple, brown, or darker-colored patches caused by bleeding under the skin. The color may vary depending on your skin tone.

Bleeding Within the Skin

ITP can also cause tiny red, purple, brown, or darker-colored spots called petechiae, often on the lower legs. These spots may look like a rash, but they’re actually caused by bleeding under the skin.

Unlike many rashes, petechiae usually don’t itch, which is an important sign that they may be a complication of ITP.

People with immune thrombocytopenia may develop petechiae — tiny red, purple, brown, or darker-colored spots that may look like a rash but are caused by bleeding under the skin. (CC BY-NC-ND 4.0 NZ/DermNet)

Excessive Bleeding

It’s easy to brush off nosebleeds or bleeding gums as nothing unusual. However, with ITP, the bleeding may be heavier than usual or harder to stop. Blood in the urine, stool, or vomit, as well as rectal bleeding, may be signs of internal bleeding and should be evaluated right away.

Heavy Menstruation

The National Heart, Lung, and Blood Institute notes that heavier-than-usual menstrual periods can occur with ITP.

Talk with your doctor if your period lasts more than seven days or includes large blood clots. If you need to change a pad or tampon more than every two hours because it’s soaked through, that’s also a sign of abnormally heavy bleeding.

Heavy menstrual bleeding should be evaluated by a healthcare professional. It can also be a sign of another medical condition and can raise the risk of anemia and fatigue.

Consider Treatment Options

Treatment may be needed when platelet counts are very low, bleeding symptoms are present, or other factors raise bleeding risk. If you or your child has ITP, talk with your hematologist about treatment options and choose a plan together.

The most common first-line treatment for ITP is a short course of glucocorticoids (a type of corticosteroid). Intravenous immunoglobulin may also be used to quickly raise platelet counts, although its effects are temporary.

If ITP doesn’t respond well enough to first-line treatment or comes back, your doctor may recommend a second-line treatment. Options include:

• Thrombopoietin receptor agonists to help the bone marrow make more platelets.
• Spleen tyrosine kinase (SYK) inhibitors to help prevent the immune system from destroying platelets
• Anti-CD20 therapies (B-cell-targeting therapies) to reduce the B cells that make antibodies that destroy platelets.
• Bruton’s tyrosine kinase (BTK) inhibitors to block a protein involved in harmful immune activity, helping reduce platelet destruction. BTK inhibitors are a newer treatment option for adults with persistent or chronic ITP that hasn’t responded well enough to previous treatment.

New treatments may become available as research continues. If other treatments don’t keep your platelet count at a safe level or prevent serious bleeding, your doctor may recommend splenectomy (surgery to remove the spleen), although this procedure is less common than it was in the past.

Monitor Symptoms Closely and Schedule Follow-Up Care

People with long-term ITP need regular follow-up appointments and blood tests to monitor their platelet counts. Your care team will consider your symptoms, medical history, and risk factors when making treatment decisions. If you take medication for ITP, you’ll also be monitored for possible side effects.

Keep your healthcare team informed about your symptoms. Don’t hesitate to contact your doctor if you think you or your child is having a serious symptom. ITP is linked to certain comorbidities (coexisting health conditions), so regular checkups are important.

Exercise Safely and Prevent Injuries

People with ITP should avoid contact sports with a risk of injury, such as football, martial arts, and boxing. Depending on your platelet count and bleeding risk, your doctor may also recommend avoiding other high-impact or high-fall-risk activities, such as skiing or cycling.

Check with your care team about what activities are safe for you. Use protective equipment, like helmets or wrist guards, when appropriate. For young children with ITP, using protective gear like knee pads or adding soft padding to sharp furniture edges may help reduce the risk of injury.

Living with ITP can make activity restrictions frustrating, but many people can stay active safely. Light to moderate activities, such as stretching, walking, gentle cycling, or resistance exercises with elastic bands, may be appropriate if your platelet count is high enough. Ask your doctor what level of activity is right for you.

Adopt a Healthy Diet

Eating a healthy diet can help support your overall health while living with ITP. If you’ve lost blood because of bleeding, your doctor may recommend eating more iron-rich foods or taking an iron supplement if you have iron deficiency or anemia.

Always talk with your doctor before taking herbal products or dietary supplements. Some supplements can interact with ITP medications, increase the risk of bleeding, or affect the immune system.

Try making gradual changes rather than big changes all at once. If you have questions about what to eat, your doctor may refer you to a registered dietitian.

Pay Attention to Your Psychological Well-Being

Living with a chronic condition like ITP can be emotionally challenging. Concerns about severe bleeding can be scary, interfere with daily life, and affect your quality of life. People living with ITP have an increased risk of depression and anxiety.

If you or someone you care for who has ITP feels anxious, depressed, or overwhelmed, tell your healthcare provider. They can help you find support, including a mental health professional who has experience working with people living with chronic illness.