Causes, Symptoms, and Treatments of ITP and TTP

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Both immune thrombocytopenia (ITP) and thrombotic thrombocytopenic purpura (TTP) are disorders that affect platelets. They may exhibit similar symptoms, however there are differences in the causes, complications, and treatments of the disorders.

ITP is an autoimmune disorder in which the immune system inappropriately destroys platelets—the cells that are responsible for helping blood clot and prevent bleeding. ITP can be treated by observation alone, or with medications such as steroids or immunoglobulin therapy.

TTP is a blood disorder in which platelets cause clots to develop in small blood vessels in the organs of the body, which can result in failure of the organs. Hemolytic anemia may also be present when red blood cells are sheared open when they pass through small blood vessels, with small clots caused by platelets.

Learn more about the key differences between ITP vs. TTP.

Forearm showing Capillaritis

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Symptoms

ITP Symptoms

Symptoms of ITP occur when there are not enough platelets in the blood to keep it from clotting quickly, which 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

Symptoms of TTP develop because the clots that develop abnormally in the blood vessels in the organs prevent 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

Causes

ITP Causes

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 Causes

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.

Complications

ITP Complications

Although not often 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 Complications

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.

Treatment

ITP Treatment

Sometimes 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 Treatment

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. 

Frequently Asked Questions

Are ITP and TTP the same thing?

No, ITP and TTP are not the same thing. Both ITP and TTP are bleeding disorders, but they occur for different reasons and may require different treatments. 

Can you have both ITP and TTP?

It is rare for both ITP and TTP to occur together, but is possible. It is most likely to occur in people who are HIV positive or those with other immunosuppressive disorders.

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.

A Word From Verywell

Getting a diagnosis of ITP or TTP for yourself or a loved one can be stressful. It is important to remember that treatment options are available and that medical treatment should be sought promptly if any symptoms of these disorders develop.

It is also important to ask your healthcare team any questions you have about ITP or TTP, to get answers, and to ensure you’re comfortable and getting good care. 

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