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ITP and MS: Can Multiple Sclerosis Cause This Bleeding Disorder?

Posted on May 13, 2022
Medically reviewed by
Evelyn O. Berman, M.D.
Article written by
Brian Niemeyer, Ph.D.

People with multiple sclerosis (MS) sometimes develop comorbidities (secondary diseases). Some members of MyMSTeam have questioned whether there’s a connection between MS and a bleeding disorder called immune thrombocytopenia (ITP) — formerly known as idiopathic thrombocytopenia purpura.

“I’ve been reading a lot about the relationship between ITP and MS,” one member wrote. “My ex-husband had ITP for two years while we were together. He made a full recovery, thankfully. Four years later, I was diagnosed with MS. What do people think about the relationship between these two diseases?”

Another member said they had both MS and ITP: “I have low platelet counts. It’s called ITP, which is an autoimmune disorder … All doctors claim no interdependency. I keep looking for the common thread.”

What Is ITP?

MS and ITP are both autoimmune disorders. MS is characterized by the degradation of the protective fatty layer (myelin) covering the nerves of the brain and spine, which comprise the central nervous system. Common symptoms of MS include fatigue, impaired motor skills, vision problems, and cognitive decline.

ITP is primarily a blood disorder where the immune system attacks platelets (the blood cells that stop bleeding). With ITP, the immune system lowers the number of platelets in the body, causing abnormalities with clotting. Normal blood clotting is an important and healthy process that prevents excessive bleeding.

ITP presents in one of two distinct forms — acute or chronic. Acute ITP is short-term, typically occurs in children, and may follow a viral infection. Chronic ITP affects adults more often than children, lasts at least six months, and can require prolonged follow-up with a health care specialist who focuses on hematology (the study of blood-related illnesses).

Symptoms

Because ITP is a blood disorder, many of its symptoms involve problems with bleeding and bruising. The drop in the number of platelets typically leads to the following symptoms:

  • Large bruising with unknown causes
  • Red, purple, or brownish-yellow specks under the skin (petechiae) caused by bleeding
  • Heavy menstrual cycles
  • Nosebleeds
  • Bleeding in the mouth and around the gums
  • Blood in urine, stool, or vomit

Many of these symptoms are in line with what MyMSTeam members have reported experiencing. “I never used to bruise much but now it seems that every little bump or pressure causes a bruise,” one member wrote. “Don’t know where they come from, just figure I’m bruising a lot easier.”

“I also have an issue with low platelets, which has been lasting over a year now,” another member said. “My numbers aren’t transfusion low, but are low enough (in the 80s) to cause easy bruising and excessive bleeding when I get cut.”

It is important to note bruising is common in people with MS and can often be a side effect of MS treatments or impaired motor skills. Bruising may not necessarily indicate ITP in people with MS, but its presence should warrant a conversation with your doctor.

Causes of ITP

ITP can be caused by several factors, including the following:

  • Immune disorders such as lupus and rheumatoid arthritis
  • Medication allergies
  • Viral infections
  • Cancer (leukemias and lymphomas)

Risks of ITP and MS

While there has been no evidence that MS itself can cause ITP, research over the years does suggest that people with MS may experience changes in their platelets. One study found that, compared to the general population, people with MS have more activated platelets. However, the significance of these findings and what they mean for those living with MS is unclear, and further research is needed to better understand any connection.

Do MS Treatments Raise ITP Risk?

Many forms of treatment are currently available to people with MS. One such treatment, alemtuzumab (sold as Lemtrada), has been linked to ITP development in people with MS.

Alemtuzumab is an antibody treatment in a class of drugs known as disease-modifying therapies. The U.S. Food and Drug Administration (FDA) approved Lemtrada in 2014 to treat relapsing-remitting multiple sclerosis. Recent case reports have shown that during treatment with alemtuzumab, up to 2.6 percent of people developed ITP.

Unlike other instances of drug-related thrombocytopenia, ITP wasn’t seen in people receiving alemtuzumab until approximately 24 months after the first treatment. This unusual delay makes it distinct from other forms of ITP.

How alemtuzumab leads to ITP in people with MS is not well understood. Current theories revolve around alemtuzumab altering platelet production and causing changes in the T cells (a type of immune cell) that promote autoimmunity.

Treatment for ITP if You Have MS

The good news is that mild cases of ITP may resolve on their own, particularly acute cases. It is also helpful to know that standard ITP treatments appear to still be effective for people with MS.

Treatments

For more severe and chronic cases of ITP that require medical intervention, there are numerous treatment options to manage and resolve low platelet counts, including:

  • Steroids — Oral corticosteroids can be used to increase your platelet count.
  • Immune globulin — Injections of immune globulin can last for a few weeks and provide a temporary boost to platelets.
  • Immune suppressors — Drugs such as rituximab (Rituxan) that suppress the immune system may stop immune-related damage to platelets.
  • Platelet boosting drugs — Therapeutics such as eltrombopag (Promacta) and romiplostim (Nplate) can jump-start the bone marrow to increase platelet production.
  • Surgery — If ITP is not responsive to drug treatments, a person may undergo a splenectomy (removal of the spleen).

An interesting point that MyMSTeam members may notice is that several of these drugs, such as rituximab and steroids like prednisone, are already therapies in use for treating MS.

When To See a Doctor

Although mild and acute cases of ITP may not require extensive treatment, it is important to understand that the disorder can be fatal. If you notice any unusual bruising or severe bleeding, you should reach out to your health care provider.

Your doctor will be able to diagnose ITP by counting the number of platelets in relation to your other blood cells through a complete blood count. Blood smears and tests for autoantibodies, which are the antibodies that target your platelet cells, can also help diagnose ITP.

If you are taking any medications associated with ITP, such as alemtuzumab, be sure to discuss them with your doctor, along with any concerns you have. Setting up a monitoring plan for ITP symptoms can be beneficial.

Talk With Others Who Understand

MyMSTeam is the social network for people with MS and their loved ones. Here, more than 186,000 members come together to ask questions, give advice, and share their stories with others who understand life with MS.

Have you been diagnosed with ITP? Or are you experiencing unusual bruising that concerns you? Share your experience in the comments below, or start a conversation by posting on your Activities page.

All updates must be accompanied by text or a picture.
Evelyn O. Berman, M.D. is a neurology and pediatric specialist and treats disorders of the brain in children. Review provided by VeriMed Healthcare Network. Learn more about her here.
Brian Niemeyer, Ph.D. received his doctorate in immunology from University of Colorado Anschutz Medical Campus.. Learn more about him here.

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