Excessive bleeding from nosebleeds, cuts, and injuries may; be a symptom of idiopathic thrombocytopenic purpura (ITP). Other symptoms are easy bruising and bloody or tarry stools that result from intestinal bleeding. Some people will have many small red dots about the size of a pinhead on the lower legs and feet, called petechiae, that are tiny hemorrhages. Others have larger hemorrhages into the skin, called purpura. Unlike other red rashes, these hemorrhages do not disappear when pressure is applied to them. In other words, if you push on the red spot, the spot does not clear for several seconds but remains red.
Idiopathic thrombocytopenic purpura means low numbers (penia) of blood platelets (thrombocytes) that promote blood clotting, causing bruises or hemorrhages in the skin (purpura) for reasons that are unexplained (idiopathic). The cause of ITP is unknown: for some reason, the body produces antibodies that attack blood platelets. ITP can occur in people who do not have HIV infection. It can occur in people with HIV infection either when the CD4 count is high or when it is low. Most people who have ITP are unaware of it; ITP is usually discovered with
routine laboratory testing. ITP is usually diagnosed when a complete blood count (a CBC) shows that the number of blood platelets is low. The usual count in healthy persons is 150,000 to 300,000 platelets per milliliter of blood. People with HIV infection often have slightly lower counts—80,000 to 120,000 platelets per milliliter—though these counts cause no problem. People with ITP often have counts that are lower yet—5,000 to 30,000 platelets per milliliter.
Treatment of ITP may consist of drugs like corticosteroids that suppress the antibodies attacking the platelets. Other treatments include AZT, interferon, or gamma globulin given intravenously. Occasionally, people have surgery to remove the spleen. All these treatments seem to be beneficial, but not always so. Some people respond to one treatment but not another, and some don’t seem to respond to anything. Other people do well with no specific treatment, despite the low platelet count. The worry with ITP is the possibility of internal bleeding, during which large amounts of blood could be lost, or vital organs like the brain or lungs could be damaged. Obviously, the person with extremely low platelet counts should be extremely careful to avoid cuts and injuries.