Immune Thrombocytopenic Purpura (ITP)

What is Immune Thrombocytopenic Purpura?

Immune thrombocytopenia (ITP), formerly called idiopathic thrombocytopenic purpura, is a condition in which IgG autoantibodies attach to platelets and lead to a low platelet count, purpura and episodes of bleeding.^[1] It can affect children and adults. ITP needs diagnosis and treatment by a physician, and a low platelet count should never be assessed or managed without medical care.

For a condition like this, we ask that you are under a physician's care for it and that your treating team knows you are receiving complementary care.

Common symptoms

Symptoms come from bleeding. Common signs are easy bruising, purpura (purple or red areas under the skin), nosebleeds or bleeding gums, and heavy menstrual periods.^{[1, 2]} Some people have fatigue, and some have no symptoms and are found by a routine blood count.

The risk of bleeding relates to how low the platelet count falls, although the link is not exact, especially at lower counts.^[3]

Causes and risk factors

In primary ITP there is no underlying cause. Secondary ITP can be triggered by drug reactions, other autoimmune diseases such as lupus, cancers such as chronic lymphocytic leukemia, and infections such as HIV.^[1] Multiple immune abnormalities lead to faster platelet destruction and reduced platelet production.^[2]

How it is diagnosed and treated conventionally

Diagnosis is made by excluding other causes of a low platelet count, with a blood count that otherwise shows normal white cells and hemoglobin.^{[1, 2]} ITP is described as newly diagnosed (up to 3 months), persistent (3 to 12 months) or chronic (over 12 months).^[1]

Treatment is not always needed. It is usually reserved for active bleeding, severe thrombocytopenia or procedures that carry bleeding risk.^[2] Corticosteroids, intravenous immunoglobulin and anti-D immunoglobulin are the usual first treatments, followed by thrombopoietin receptor agonists, rituximab, fostamatinib, splenectomy and other options if needed.^{[2, 4]} Guidelines stress shared decision-making and strategies that avoid medication side effects.^[4]

Why Immune Thrombocytopenic Purpura calls for a whole-person approach

ITP is an immune condition, but living with it affects more than the blood count. It can become chronic in many adults, which places a burden on quality of life, and treatment itself aims to raise platelets to a safe level with minimal toxicity while improving quality of life.^{[2, 3]}

Supportive care can help with the burdens around the diagnosis. It cannot raise platelet counts or replace specialist treatment.

Immune system activity

ITP involves immune abnormalities of both antibodies and immune cells, and a more detailed understanding is leading to new targeted drugs.^{[2, 3]} This is why immune-suppressing treatments are the center of medical care, and why anything that claims to alter immunity needs your hematologist's approval.

Infections and other triggers

Infections, certain drugs and other autoimmune diseases can all be linked to ITP.^[1] Your doctor should review any new medicine or supplement as a possible contributor.

Stress, sleep and quality of life

Chronic ITP can weigh on mood and daily life, and guidelines include quality-of-life considerations as part of care.^[5] Stress and poor sleep are common, and these are the symptoms supportive therapies are most often aimed at.

Bleeding risk in daily life

Because bleeding is the central risk, anything that affects clotting, from medicines and herbs to needles and massage pressure, deserves care. The safety sections below focus on this.

Acupuncture as supportive care in Immune Thrombocytopenic Purpura

What the research shows

There are no clinical trials of acupuncture for ITP. We found none in PubMed, and no evidence suggests acupuncture raises platelet counts or treats the disease.

Evidence for symptoms in other groups is limited. A review of 24 trials, 15 of which were pooled in a meta-analysis, found that acupuncture improved sleep quality in people with insomnia compared with medication, with effects appearing after about 3 weeks, though results varied widely between studies.^[6] These studies did not involve ITP.

How acupuncture may work

No studies have looked at how acupuncture might act in ITP. Any benefit for sleep or stress would be a general effect on the nervous system and would not be expected to change platelet counts.

What treatment involves

Acupuncture uses fine, sterile, single-use needles, usually left in place for about 20 to 40 minutes. Because ITP is a bleeding-risk condition, your hematologist should know about the plan and can tell you whether acupuncture is reasonable at your current platelet count, especially if counts are low or bleeding is active.

Safety data in low platelet counts are limited. In two retrospective chart reviews of patients with cancer-related thrombocytopenia, no significant bruising or bleeding was recorded after acupuncture, including at platelet counts below 50,000 per microliter, but those were not people with ITP and the authors called for prospective studies.^{[7, 8]} In general prospective studies, about 9 in 100 patients had a minor reaction such as brief bleeding or soreness, and serious events occurred in about 1 in 10,000 patients.^[9] Tell the practitioner first about any bleeding or bruising, blood thinners, steroids or immune-suppressing drugs, and a pacemaker (relevant to electroacupuncture).

Ayurvedic medicine as supportive care in Immune Thrombocytopenic Purpura

The Ayurvedic view

Ayurveda describes bleeding into the skin, such as purpura, under the heading of Raktapitta or Rakta-related disorders, and usually links it with aggravated Pitta in the blood tissue (rakta dhatu). This is a traditional framework, not a medical diagnosis.

Therapies that may be used

Traditional supportive care is gentle and individualized. It may include cooling, easily digested meals, regular routines, rest and calming practices such as slow breathing. Individually prescribed herbs may be considered only after medical review.

Panchakarma and strong cleansing procedures are not appropriate with a low platelet count, active bleeding, acute illness or frailty. Deep massage and heat treatments should also be avoided unless your hematologist agrees.

What the research shows

There are no clinical trials of Ayurvedic treatment for ITP. For symptoms in other groups, a meta-analysis of 12 trials found that ashwagandha lowered anxiety and stress compared with placebo, with low-certainty evidence.^[10] Another of 5 trials found a small benefit for sleep, with limited safety data.^[11] None of these included people with ITP, and ashwagandha should not be taken by anyone with ITP without the hematologist's approval.

Herbal medicine as supportive care in Immune Thrombocytopenic Purpura

Herbs and formulas that have been studied

Several Chinese herbal formulas have been tested in ITP, almost all in China. They include Shengxuexiaoban capsules with corticosteroids, Huaiqihuang granule, Guishao Shengxue decoction and Shengxueling, whose main component is ginseng saponins.^{[12, 13, 14, 15]} Formulas are chosen in traditional practice by pattern and are not interchangeable.

What the research shows

The evidence comes only from studies in China and is of mixed quality, though it includes two placebo-controlled trials in children. A meta-analysis of 27 trials found that adding Shengxuexiaoban capsules to corticosteroids gave better response rates, fewer relapses and higher platelet counts than steroids alone, with intermediate-quality evidence for relapse and overall response.^[12]

In a double-blind, placebo-controlled trial of 216 children with chronic ITP at 13 hospitals in China, Huaiqihuang granule gave a higher clinical effectiveness rate (about 72% versus 46% at 24 weeks) and less bleeding than placebo.^[13] A smaller placebo-controlled trial of 42 children with persistent or chronic ITP reported higher response with Guishao Shengxue decoction added to conventional care.^[14] An older trial of 69 patients reported a better response with Shengxueling than with a nutritional comparator, but it was small and not placebo-controlled.^[15]

These trials were run in one country, used specific formulas, and are not proof that herbs are effective in other settings. They do not show that herbs can replace standard treatment, and the studies in children are not a basis for giving herbs to a child.

Safety and herb-drug interactions

Herbs that affect clotting can add to bleeding risk. A literature review described bleeding when ginkgo was combined with warfarin or aspirin, and enhanced anticoagulation with danshen and garlic.^[16] The same review noted effects on ciclosporin and tacrolimus levels from St John's wort, which matters for people taking immune-suppressing drugs.^[16] Ginseng, which is also used in some Chinese formulas, was reported to alter warfarin levels.^[16]

Herbal and dietary supplements are also a known cause of liver injury.^[17] About one fifth of Ayurvedic medicines bought online contained detectable lead, mercury or arsenic, so any product should come from a tested source.^[18] Tell us about all medicines, pregnancy or breastfeeding plans, and liver or kidney disease. No herb should be started without your hematologist's knowledge.

Translating traditional medicine into modern biological language

This is interpretation, not equivalence. Chinese medicine often describes ITP-type bleeding in terms such as blood heat, qi that fails to hold the blood, or yin deficiency. Ayurveda links it to aggravated Pitta in the blood. Researchers studying Chinese formulas in ITP have measured immune markers and platelet-associated antibodies, but these links are early and unconfirmed.^[14]

No study has shown that a TCM pattern or a dosha corresponds to the antibody-mediated platelet destruction seen in ITP.

How this care fits with your medical care

Supportive care comes after medical care. Keep your appointments and blood tests with your hematologist, and do not stop or change corticosteroids or any other prescribed treatment. Stopping steroids suddenly can be dangerous, and any change must be made by your prescriber.

We do not diagnose or manage ITP. Please bring your diagnosis, your most recent platelet counts, a list of all medicines and supplements, and your hematologist's guidance on activity and procedures.

When to seek urgent medical care

Bleeding with a low platelet count can become serious quickly.

• A nosebleed or gum bleeding that does not stop after 10 minutes of pressure
• Blood in the urine or stool, black stools, or vomiting blood
• A sudden severe headache, confusion, vision changes or weakness, which can signal bleeding in the brain
• A head injury or a bad fall
• New widespread bruises or blood blisters in the mouth
• Very heavy menstrual bleeding soaking a pad or tampon every hour

If any of these occur, call 911 or go to the nearest emergency department.