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ITP in dogs: very low platelets and what they mean

In immune thrombocytopenia (ITP), the immune system destroys the dog’s own platelets, the small cells that plug leaks in blood vessels. Platelet counts can fall close to zero, causing small bruises and bleeding. ITP is the most common acquired bleeding disorder of this type in dogs, but it is a diagnosis of exclusion.

Written by the AI DiagAnimals editorial teamReviewed by the AI DiagAnimals TeamUpdated Our editorial policy

The essentials

ITP is suspected when a dog has a platelet count well below normal, confirmed on a blood smear, with small bruises, red spots or bleeding. Spontaneous bleeding is usually seen when platelets fall below about 30,000/µL. Vets first rule out a false low count (clumps, or the naturally large platelets of Cavalier King Charles Spaniels), then look for triggers: tick-borne infections, drugs and cancer. Black, tarry stools are a sign of severe disease. Most dogs survive with treatment.

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Signs of ITP

  • Tiny red or purple spots (petechiae) on the gums, belly or inner ears, and bruises [1, 2].
  • Nosebleeds, blood in the urine, bleeding in the eye [1, 2].
  • Black, tarry stools (melena): common, and linked to a higher need for transfusion and a poorer outcome [2].
  • Often a dog that otherwise seems fairly well [3].

How low the platelets go

The ACVIM diagnostic algorithm starts from a platelet count below 100,000/µL confirmed by examining a blood smear [1]. In ITP the count is often much lower: in 30 dogs the median was 8,000/µL, and 77% had fewer than 30,000/µL [4]. Bleeding risk rises as the count falls: below 30,000/µL bleeding can be spontaneous, and below 10,000/µL the risk is highest [3].

An annotated line from a lab report · Illustrative example
AbbreviationResultUnitLaboratory intervalFlag
PLT Platelets9K/µL148–484L
  1. Abbreviation PLT or platelets.
  2. Result 9 K/µL (9,000/µL) in this illustrative line: severely low.
  3. Unit K/µL, 10³/µL, 10⁹/L or G/L: the same number.
  4. Laboratory interval An illustrative dog interval; each laboratory sets its own.
  5. Flag L: below the interval. A smear confirms the count and checks for clumps before ITP is considered [1]. See low platelets in dogs.

Ruling out a false low count

  • Platelet clumps lower the count with every method; if clumps are seen, a new sample is taken [1, 5].
  • Inherited large platelets: Cavalier King Charles Spaniels, Norfolk and Cairn Terriers and some other breeds can have counts of 30,000 to 150,000/µL without being ill; some analysers miss the large platelets, so a smear estimate is used [3].

Looking for a trigger

ITP remains a diagnosis of exclusion [1]. The consensus recommends a history of vaccines, drugs, toxins, travel and exposure to ticks and fleas, a blood count with smear review, chemistry and urinalysis, and testing for Ehrlichia, Babesia and Anaplasma with both antibody tests and PCR; Leishmania is tested where relevant [1]. Some drugs, including sulfonamide antibiotics, can trigger ITP, and lymphoma and other cancers have been implicated [1, 3]. Thrombocytopenia after vaccination is generally mild [3]. See tick-borne diseases in dogs.

Outlook

Reported mortality ranges from 10% to 30% [1]. In 73 dogs, 84% survived to discharge; melena and a high BUN (often from blood digested in the gut) were linked to lower survival [6]. Relapses occur in 9% to 47% of dogs, so platelets are rechecked regularly [2]. The platelet count at admission should not be used on its own to predict the outcome [1].

Related articles

En français : la thrombopénie immune du chien.

Questions to ask your veterinarian

  1. Was the low platelet count confirmed on a blood smear?
  2. Could clumps or my dog’s breed explain a falsely low count?
  3. Which tick-borne infections, drugs or other causes should we rule out?
  4. Is there bleeding into the gut, and is my dog anemic?
  5. How often will we recheck the platelets?
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Frequently asked questions

What is the most common cause of low platelets in dogs?

There are many: infections such as tick-borne diseases, immune destruction (ITP), consumption in clotting disorders, bone marrow disease, and false low counts from clumps. ITP is diagnosed only after the others are excluded [1, 3].

Is there a cure for ITP in dogs?

Most dogs respond to treatment, and 84% survived to discharge in one study. Relapses are possible, so follow-up counts matter [2, 6].

How low can platelets go before bleeding?

Spontaneous bleeding is usually seen below about 30,000/µL and is most likely below 10,000/µL [3].

Which organ destroys platelets?

In ITP, antibody-coated platelets are mainly removed by the spleen and liver.

Which dogs get ITP?

Any dog can. Cocker Spaniels were overrepresented in one study, and females in another [4, 6].

Sources

  1. LeVine DN et al. ACVIM consensus statement on the diagnosis of immune thrombocytopenia in dogs and cats. J Vet Intern Med. 2024;38(4):1958-1981. doi.org/10.1111/jvim.16996
  2. LeVine DN et al. ACVIM consensus statement on the treatment of immune thrombocytopenia in dogs and cats. J Vet Intern Med. 2024;38(4):1982-2007. doi.org/10.1111/jvim.17079
  3. eClinPath, Cornell University College of Veterinary Medicine. Platelet numbers. eclinpath.com/hemostasis/disorders/platelet-numbers
  4. Putsche JC, Kohn B. Primary immune-mediated thrombocytopenia in 30 dogs (1997-2003). J Am Anim Hosp Assoc. 2008;44(5):250-257. doi.org/10.5326/0440250
  5. eClinPath, Cornell University College of Veterinary Medicine. Platelet count. eclinpath.com/hematology/tests/platelet-count
  6. O’Marra SK et al. Treatment and predictors of outcome in dogs with immune-mediated thrombocytopenia. J Am Vet Med Assoc. 2011;238(3):346-352. doi.org/10.2460/javma.238.3.346

Laboratory methods and reference intervals vary. This article explains; it does not diagnose. For a decision about your pet, use the original report and talk to your veterinarian. Our editorial policy.

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