ITP - General Information

What is ITP?

Immune Thrombocytopenia, or ITP, is an autoimmune disease is a condition in which the immune system attacks cells in the body. In the case of ITP, the immune system attacks healthy platelets and/or suppresses platelet production, resulting in low platelet counts.

A patient with ITP typically has a platelet count of between 0 (severe ITP) and 100 (mild ITP), while a healthy platelet count will range between 150 and 450 x 109/L (or 150,000 – 450,000).

Treatment is aimed at achieving a platelet count > 20 x 109/L (or 20,000), and avoidance of severe bleeding.

Common Symptoms

  • Fatigue
  • Easy and spontaneous bruising
  • Petechiae
  • Prolonged bleeding from cuts
  • Epistaxis
  • Bleeding gums
  • Mucosal blisters
  • Heavy menstruation
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When a Person with ITP is Seeking Assistance

Recommended Action

  • Talk with the person living with ITP or their family member about the history of their disease.
  • Understand the symptoms that brought the person in to see you today.
  • Obtain an FBC to determine the person’s current platelet count.
    • Some people living with ITP have platelet clumping, which occurs with regular blood draws.
  • Ask the person if they have an existing ITP plan.
  • Contact the haematology treatment centre.

When to Treat

The decision to treat should factor in not only the platelet count but also individual bleeding risk (based on personal history and comorbidities), disease stage (newly diagnosed v persistent or chronic), side effects of treatment, age, concomitant medications, and patient preference. We recommend treatment for newly diagnosed ITP when platelet counts are consistently < 20 × 109/L, even in the absence of bleeding (GRADE 1C)., If the patient has no or only mild bleeding and platelets > 20 × 109/L, then a watch‐and‐wait strategy is usually appropriate (GRADE 2C).

 

Source: Medical Journal of Australia

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Things to Remember

  • Most people living with ITP are highly knowledgeable about their disease and the treatments that do and do not work.
    • Not all treatments will work for every person.
  • Talk with the person about their history and use their knowledge to your advantage.
  • Review the ITP Guidelines – Adult Guidelines and Paediatric Guidelines
  • Download a copy of the Treatment Information Sheets – Adult Treatments and Paediatric Treatments
  • ITP Treatment Guidelines

Shared Decision-Making

Why Shared Decision Making Matters

Shared decision-making is when clinicians and patients collaborate, putting people at the centre of decisions about their treatment and care.

Shared decision-making also supports people to develop the knowledge, skills, and confidence they need to manage and make informed decisions about their health and health care.

For care to be enabling, the relationship between clinicians and patients needs to be a partnership rather than just the health care professional directing.

Shared decision-making supports people to develop the knowledge, skills, and confidence they need to manage and make informed decisions about their own health and health care.

When Patients and Clinicians Make Decisions Together

  • Both the clinician and patient understand what is important to the other.
  • Patients feel empowered to make informed choices, and their treatment and care plan take into account their perspective.
  • Health and other care professionals can tailor the care or treatment to the needs of the individual.

The Benefits for ITP Patients

  • The care and support patients receive should consider their needs and preferences.
  • Patients have the right to be involved in discussions and make decisions about their treatment and care, together with a healthcare professional.
  • They should feel empowered to clarify issues relating to their treatment and care with you, the healthcare professional.
  • The person’s circumstances may change over time, so it is important that the treatment plan is continuously reviewed and a joint decision is made regarding the future approach.
  • The treatment approach should be designed for adolescents to allow normal life and activity, including schooling, as far as possible. The potential impact of having a chronic condition and the effect of treatment, particularly steroids, on causing changes in mood should be explored and understood.

This information is intended for healthcare professionals, including emergency department clinicians, nurses, and general practitioners who have someone with Immune Thrombocytopenia come to them seeking medical assistance. The information provided is general only and should be used as a guide.

We strongly recommend contacting the patient’s haematology treatment centre for personalised treatment information.