Causes, Symptoms, and Treatments of ITP and TTP

Immune thrombocytopenia (ITP) and thrombotic thrombocytopenic purpura (TTP) are both blood disorders that affect platelets and may exhibit similar symptoms, such as unexplained bruising, bleeding, and fatigue.

However, ITP, also called idiopathic thrombocytopenic purpura, is an autoimmune disorder that may only require monitoring. In contrast, TTP is related to an enzyme that controls how blood clots and leads to life-threatening complications if not treated right away.

Learn more about the differences between ITP and TTP. Make sure to see a healthcare provider for a diagnosis, so you can receive the proper treatment.

Symptoms of ITP vs. TTP

ITP and TTP are both blood disorders and can have similar symptoms.

ITP

Symptoms of ITP occur when there are not enough platelets in the blood to keep it from clotting quickly. This may cause blood to leak from small blood vessels. Although ITP may not exhibit any symptoms at all, some symptoms may include:

• Bruising: possibly with no known cause
• Petechiae: small, pinpoint red spots often occurring in groups on the skin
• Bleeding from the gums or blood blisters in the mouth
• Nosebleeds that may occur frequently
• Heavy menstrual cycles
• Blood in urine, stool, or vomit
• Fatigue
• Stroke-like symptoms

TTP

Symptoms of TTP develop when platelets cause clots in small blood vessels, preventing the organs from functioning properly. As the platelets are used up in the abnormally formed clots, other areas of the body may experience bleeding. Symptoms of TTP may include:

• Nervous system: headaches, vision changes, confusion, speech changes, seizures
• Urinary system: kidney failure, swelling to the lower extremities, blood in the urine
• Skin: bruising, bleeding in the mouth, pale skin
• Other: abnormal labs (anemia, electrolyte imbalances), nausea, vomiting, heavy menstrual bleeding, weakness, fatigue, abdominal pain

Hemolytic anemia, which is when red blood cells are destroyed faster than they are replaced, can occur with TTP. This happens if red blood cells get sheared open as they try to squeeze around the blood clots.

Causes of ITP vs. TTP

ITP is an autiommune disorder in which the body destroys its own platelets. TTP can occur if you do not have the right amount of an enzyme that controls how your blood clots.

ITP

Antibodies are produced by the immune system when responding to fight off a foreign substance, such as bacteria, a virus, or another infection. In ITP, the immune system inappropriately produces antibodies against platelets, triggering the immune system to destroy them.

It is not always known exactly what causes this to happen, but it may be more likely in people with other autoimmune disorders. ITP sometimes occurs following a viral infection, especially in children.

TTP

Although the exact cause of TTP is not always known, it is usually found to be associated with a deficiency in an enzyme called ADAMTS13. Without enough of this enzyme, excessive clotting of the blood can occur.

This deficiency can develop as a result of an autoimmune disorder or may be inherited if a child receives a copy of the defective gene responsible for ADAMTS13 production from each of their parents.

ITP vs. TTP Complications

Prompt treatment is required to prevent life-threatening complications from TTP. Life-threatening complications from ITP are more rare, but they can occur.

ITP

Although uncommon, life threatening complications can occur from ITP.

Uncontrolled or excessive bleeding is one of the main complications of ITP. Catastrophic bleeding, such as bleeding in the brain or from major organs, may be experienced.

Bleeding may lead to anemia, or low red blood cell counts in the blood, and this may lead to extreme fatigue and exhaustion.

TTP

Severe, life-threatening complications may occur if TTP is not treated promptly. The clots in the blood vessels may prevent adequate blood flow to the organs, resulting in organ failure. This can potentially happen to any affected organ, such as the kidneys or liver.

Treating ITP vs. TTP

Treatment is essential for TTP, but it may not be required for ITP.

ITP

Sometimes only observation is needed. ITP does not require any treatment if platelet counts remain adequate and no significant symptoms occur. ITP may also resolve on its own.

The goal of treatment, when required, is to stop or prevent bleeding and improve platelet counts. The initial treatment is typically steroid medication. Steroids work by suppressing the immune system and stopping the destruction of platelets. 

If ITP does not improve after the use of steroids, medications such as an intravenous infusion of immunoglobulins or a gamma-globulin infusion may be necessary. 

Other treatments used for ITP in subsequent lines of therapy include:

• Surgical removal of the spleen
• Medications to stimulate the bone marrow to increase platelet production
• Antibody infusions to stop antibody production against platelets

In rare cases, chemotherapy medications may need to be given. 

TTP

A treatment called plasma exchange is needed to treat TTP.

During plasma exchange, blood from the person with TTP is removed and filtered through a special machine. In this machine, the plasma is filtered out, removing the antibodies that are responsible for starting the disease. The other blood products are returned to the person, and healthy plasma from a donor is transfused. 

Additional treatments for TTP include steroids and a medication called Cablivi, which can prevent the development of blood clots. These treatments are typically given in combination with plasma exchange. 

Summary

Both ITP and TTP are disorders that affect platelets. While they may exhibit similar symptoms, there are differences in the causes, complications, and treatments of the disorders.