We listen. We Care. Evidence-based Medicine

PART 1 :

Q : What are platelets?

Platelets are a type of blood cell that are responsible for your blood to clot. 

When there is insufficient platelets, as in ITP, there is a higher chance of bleeding or bruising.​


Q : What are the ymptoms related to low platelet count "thrombocytopenia" ?

The symptoms vary greatly from person to person. 

Most people experience spontaneous bruising or petechiae.

Others include bleeding in the gum, blood in urine or stool, heavy or prolonged menstruation

Q : What are the reasons for low platelet count ?

1)  A decrease in production. (the “blood factory” does not produce enough platelets) such as : bone marrow infiltration, leukaemia, Myelodysplastic Syndrome, etc. 

2)  Excessive destruction in the blood circulation. (platelets are produced adequately in the “blood factory”, but when they are in the blood circulation, they are being destroyed) such as : ITP, cirrhosis of the liver, etc.

Other reasons include drugs/ herbs, viral infection, alcohol, etc.

Q : How to treat low platelet condition(s) ?

The treatment for low platelet condition very much depends on the cause of the low platelet count and how low the platelet count is.

 ​If the platelet count is very low, your doctor may recommend platelet transfusion.


PART 2 :

Q:  I’ve just been diagnosed with ITP. What is that? 

ITP stands for Immune Thrombocytopaenia.

It is a condition where a person's blood has a lot fewer platelets than normal.  Platelets are the parts of your blood that cause clotting and stop bleeding.

In ITP, the platelets are being “attacked” by your own immune system and are removed from the blood through the spleen.

Q: How is ITP diagnosed? 

ITP is a diagnosis of elimination.  Your doctor will do tests that rule out other causes of low platelets.  If no other cause is found, the the diagnosis is often ITP.  Commonly doctors will test for other diseases such as lupus and do a bone marrow examination.


Q: What treatments are available for ITP?

 ITP treatment is usually aimed at keeping your platelet count above 30,000 to 50,000 per microlitre (but that can depend on your body, your lifestyle, and your doctor).

There are many types of treatment for ITP.  They all have different risks and benefits.  It is important to understand both the success rate and potential side effects before beginning treatment.  Haematologists may use these treatments in combination to increase their success rate.


Types of Treatment : a quick summary

1. Corticosteroids : Two of the things they do is dampen down(suppress) the immune system and reduce inflammation.

​2. Immunoglobulins : In ITP, immunoglobulins are harvested from blood donations and used to stop the spleen from destroying platelets.

3. Splenectomy : this is a surgical procedure in which your spleen is removed.  In ITP, the spleen also destroys your own platelets, so taking it out can slow down the destruction and leave you with more platelets in your blood.


Q: How long will I have to be treated for ITP?

 ​ITP is a chronic disease, which means it keeps going.  There are a lot of treatment options.

Remember that no one treatment is right for everybody, but because there are so many options, there is a good chance that you can find a treatment that is right for you.

Q: What can I expect from prednisolone?

While prednisolone helps many people with ITP, it has side effects that many patients find difficult to deal with. 

Most people experience bloating, weight gain, loss of muscle tone, joint aches, gastritis, and irritability. Long term or high doses can contribute to osteoporosis, high blood pressure, diabetes, muscle wasting.

Because most people find their platelet count drops as they discontinue prednisolone and the side effects cause problems, your haematologist may prescribe prednisolone only for a short time or recommend an alternative treatment.

Q:  Will I bleed to death from ITP?

 Life-threatening bleeding in very rare.  When it does happen, the most dangerous type is intracranial (inside the head), combined with a very low platelet count.

 ​Being careful of your head is always a good idea!

Q:  What will happen if I have ITP and want to have a baby?

 Many women with ITP deliver fine, healthy babies, although this is not without some risk. 

 ​Your decision to have a child and your treatments during pregnancy depend on your count, symptoms, and overall health and should be discussed with your haematologist and obstetrician.




Q : What should I do if I have low platelet count ?

You can arrange for a second blood count to confirm if you have low platelet counts. 

If this is confirmed, you may seek a referral or arrange a consultation with a haematologist to determine the cause and the next course of action.

Q : What to watch out for if I have low platelet count ?

It is important to avoid strenuous physical activities, and substances, such as alcohol, blood-thinning medicine (e.g. aspirin, clopidogrel), unknown self-prescribed, over-the-counter medicine/herbs, if you have very low platelet counts. 

All these are aimed at avoiding serious life-threatening internal bleeding and worsening of platelet count in someone who is facing a low platelet count problem.




Q:  What causes low platelet in ITP?      

>Increased platelet destruction

- Autoantibodies, cytotoxic B/T-cells

-Target: platelets

>Impaired platelet production

-Autoantibodies, cytotoxic B/T-cells

-Target: megakaryocytes

Q:  What is bone marrow examination?

Platelet are produced in the bone marrow.  The test is done to confirm that the platelet production process is working properly.   The test is typically done at the hip bone.  First a shot of numbing agent is given, then a needle is pushed through the bone and into the marrow.

Q: What are the treatment options ?

*Decrease Platelet Destruction

Decrease platelet clearance by RES - Corticosteroid, IVIG, anti-RhD, splenectomy

Inhibit Antibody Production - Corticosteoid, Rituximab, Mycophenolate, Azathioprine, Cyclophosphamide, Cyclosporine

*Increase Platelet Production 

TPO receptor agonists - Romiplostim, Eltrombopag



4. Immunosuppressions : these are powerful medicines that dampen down the immune system.  In ITP, these drugs slow down the rate at which your body destroys your platelets.

5. Thormbopoietin-like agents (TPO receptor agonists) : the newest class of ITP treatments.  These agents act like the proteins your own body uses to tell your bone marrow to make more platelets.

​6. Monoclonal antibodies : these are custom-made antibodies that cause your body to destroy the cells that are causing your platelets to be destroyed.  


Q:  Is there one treatment that is usually recommended?

 An initial course of prednisolone is often given to newly diagnosed patients.  Prednisolone suppresses your immune system. 

 ​It is hoped that suppressing your immune system will cause your platelet count to increase and remain elevated after you are no longer taking prednisolone.

Q: Can ITP be cured ?

 ITP can be acute and improve in less than six months.  ITP can also be chronic and linger for many years.  The disease can go into remission for a long time, perhaps for the remainder of a person’s life.  ITP can also recur.  There is currently no way to predict the course of the disease.

 Some patients with ITP may decide to live with a low, but safe count, continuing to closely monitor their situation with their haematologists.


Q:  Can I give ITP to anyone else?

No, you can't.  ITP is not usually considered a disease that can be passed from one generation to another.

It is not believed to be an inherited disease.           


Q:  Can I give ITP to my chidren?

 If you are a woman who has ITP and become pregnant, some of the anti-platelet antibodies may cross the placenta and  your baby may temporarily develop low counts. 

 ​If this happens, the baby may be treated to prevent bleeding.  When the baby’s own immune system matures, the platelet count improves.



Q : What is normal platelet count ?

Normal : 150,000 to 400,000 /uL

Severe ITP : < 10,000-20,000 /uL

> 30,000 /uL, - relatively safe count, usually high enough to protect against bleeding in the brain in most cases.

Q: What is the life span of platelet ?

5-7 days

Severity of Thrombocytopenia

In general, the more bleeding symptoms you have, the lower your platelet counts.

A mild thrombocytopenia may not give rise to bleeding and can only be detected on blood count test.

Easy bruising


Bleeding in the Brain

Random Donor Platelets


Single Donor (Apheresis) Platelet

Monoclonal Antibody





Efficacy: sustained long term response : 66%

Safety : Short term complications : 12.9%

Long term complications : infection, thrombosis, atherosclerosis