8 Effective Ways to Manage Fatigue From Immune Thrombocytopenia
Health ConditionsRare DiseasesImmune Thrombocytopenia

8 Ways to Prevent and Manage Fatigue When You Have Immune Thrombocytopenia

Fatigue can have a significant impact on daily life, but there are strategies that can help.
8 Ways to Prevent and Manage Fatigue When You Have Immune Thrombocytopenia
Everyday Health
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Published on January 27, 2025
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If you have immune thrombocytopenia (ITP) and are struggling with fatigue, you’re not alone. In an international survey of 1,507 people with ITP, as many as 73 percent reported fatigue as their most severe symptom, and 58 percent said it was their most frequent symptom.

 And in another, smaller study, over 93 percent of the participants reported that fatigue was a major symptom that affected their lives.

Fatigue can make it difficult to engage in daily routines and activities and reduce overall quality of life in people with ITP. “It can be a vicious cycle,” says Alexandra Wolanskyj-Spinner, MD, a hematologist at Mayo Clinic in Rochester, Minnesota. “Fatigue leads to a lack of motivation for exercise and eating well, which can impact your mental health and lead you to not sleep well, which causes fatigue.”

The good news is, there are ways to avoid — or at least minimize — this vicious cycle. Keep reading to learn what could be causing your fatigue, plus some simple ways to help prevent and manage it.

Common Causes of Fatigue in ITP

The causes of fatigue in ITP are not completely understood, but many people with the condition say the fatigue is worse when their platelet count is low.

In some cases, though, someone who has ITP may experience fatigue even when their platelet count is managed. According to James Martin, MD, a hematologist at Cleveland Clinic, fatigue that persists despite treatment may be due to more than one cause.

Some possible reasons you may experience fatigue when you have ITP include:

Anemia According to the Platelet Disorder Support Association, the excessive bleeding that comes with ITP can lead to anemia, a condition characterized by low levels of red blood cells. In people with anemia, there aren’t enough healthy red blood cells to carry adequate oxygen to the body’s tissues, and this often results in extreme fatigue and low energy levels.

Cytokines ITP is an autoimmune disease, says Dr. Wolanskyj-Spinner. The root of autoimmune disease is inflammation, and when your body is inflamed, cytokines (proteins that help control inflammation in your body) are released, which can cause fatigue.

Comorbidities ITP may be secondary to an underlying disease, such as lupus, a chronic autoimmune disease.

Low Vitamin D Levels This is common in people who have ITP. One study exploring the non-disease-specific reasons for fatigue with ITP found that a vitamin D deficiency can be a cause.

Depression Another study found that depression, excessive daytime sleepiness, and sleep apnea are underestimated factors that commonly occur in people with ITP. These can also increase fatigue and affect quality of life.

Steroids Wolanskyj-Spinner says steroids, which are commonly used to treat ITP, are a double-edged sword. “They are wonderful in their ability to rapidly decrease inflammation, but their side effects can cause insomnia and depression, affecting overall well-being and contributing to fatigue,” she says.

8 Ways to Beat Fatigue if You Have ITP

The first line of treatment for fatigue is steroids to help increase your platelet count. This works in the majority of people with the condition, says Dr. Martin. If a second treatment is needed, your doctor may prescribe an intravenous therapy of rituximab (Rituxan) — a monoclonal antibody that stops the destruction of platelets — or an oral thrombopoietin receptor agonist, which forces the production of platelets. These measures can help improve fatigue.

You can also help prevent or manage the fatigue that comes with ITP in some other ways:

    1. Speak up: Mention it to your doctor. “Doctors may not ask you about your fatigue, because they are trying to save your life,” says Wolanskyj-Spinner. Doctors tend to focus on the urgent need to treat the disease, so they may not be considering its impact on other areas of your life, she notes.
    2. Get regular exercise. Wolanskyj-Spinner recommends aiming for 20 minutes a day of movement, which can be broken up into smaller chunks of time. When you exercise, your muscles release chemicals that may improve sleep.

    3. Prioritize good sleep hygiene. A consistent good night’s sleep is important for overall health. It can affect everything from mental clarity to food choices. Go to bed at a consistent time and avoid things that can stimulate you before bedtime, such as caffeine and screens.
    4. Ask your doctor about complementary therapies. These may include vitamin D supplements, massage, meditation, breath work, or cognitive behavioral therapy. Vitamin D supplements are especially important, as they are associated with a better treatment response and less severe disease.

    5. Eat a balanced diet. To help prevent anemia, your diet should include a wide variety of foods rich in iron, such as beans, broccoli, chicken, eggs, lean beef, and lentils.

    6. Limit steroid use. Because steroids can cause insomnia, Wolanskyj-Spinner says they should be used with caution. Talk to your doctor if you think your medication may be interfering with your sleep.
    7. Consider your mental health. Talk to your medical team about your stress levels and let them know if you have depression. Dealing with a chronic illness, such as ITP, is associated with depression, as is steroid use.

    8. Talk to your doctor about any concerns or changes. If symptoms are no longer responding to medication, your treatment plan may need to be reevaluated. Bring up your concerns when you see your doctor.

The Takeaway

  • Fatigue is a common symptom of immune thrombocytopenia.
  • It can have a significant impact on daily function and quality of life.
  • In addition to treatment for ITP, measures such as getting good sleep, regularly exercising, and eating a healthy diet can help with fatigue.
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Anna C.E. Hurst, MD, MS, FACMG

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Anna C. E. Hurst, MD, is a medical geneticist with board certification in clinical genetics and pediatrics. She is an associate professor in the department of genetics at University of Alabama at Birmingham (UAB) and an adjunct faculty member at the HudsonAlpha Institute for Biotechnology. Prior to medical school, she received a master’s degree in genetic counseling, which inspired her interest in the communication of genetic information to patients and families with rare diseases.

Dr. Hurst is a physician for the UAB Undiagnosed Disease program, Turner syndrome clinic, and general genetics clinic, and she provides hospital consultations for inpatients at UAB and Children’s of Alabama for general genetics and inborn errors of metabolism. She also is the medical geneticist for the Smith Family Clinic for Genomic Medicine in Huntsville, Alabama.

Hurst's research focuses on expanding the availability of genomic sequencing for children with complex healthcare needs. She also has an interest in how the patient’s physical exam and facial features can be clues to a rare disease diagnosis (dysmorphology) and serves on the scientific advisory board of Facial Dysmorphology Novel Analysis. She has published over 45 peer-reviewed articles in the field of medical genetics, largely focused on the clinical delineation of rare disease phenotypes. She also serves as an associate editor for the American Journal of Medical Genetics.

Hurst is also passionate about education and serves as the program director of the UAB genetics residency programs (categorical, pediatrics-genetics, and internal medicine-genetics) and medical director of the UAB Genetic Counseling Training program. She is an officer with the Association of Professors in Human Medical Genetics.
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Nina Wasserman is a journalist with more than a decade of experience interviewing people and writing on a variety of topics, including health, medicine, business, and faith, as well as human interest stories. Wasserman also home-schools her two children in New Jersey and teaches writing to middle school students. Her passion is foraging for mushrooms and edible plants in the woods, a practice that contributes to her health and wellness.

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Resources
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  5. Alesci RS et al. Identification of an Unmet Medical Need: Height of Depression, Hypersomnia, and Sleep Apnea Positively Correlate With the Level of Fatigue in Patients With Immune Thrombocytopenia. Cureus. October 13, 2023.
  6. Tan X et al. The Role of Exercise-Induced Peripheral Factors in Sleep Regulation. Molecular Metabolism. December 2020.
  7. Mabrouk RE et al. Sufficient Vitamin D Is Favorable for Children With Persistent and Chronic Immune Thrombocytopenia. Annals of Hematology. August 2023.
  8. 52 Foods High in Iron. Cleveland Clinic. March 15, 2023.
Additional Sources