I was diagnosed with ITP July, 2015. For a long time, my "normal" was around 40,000. It didn't affect my energy level. I was able to keep up with an active, social lifestyle. Last February, after a bout of pneumonia, my platelets dropped to 13k, so I was put on Promacta. By being on 50 mg, my platelets are staying around 60-75k. I'm happy with that, but I am really struggling with fatigue and arthritic-like pain in my knees, elbows, and wrists. I try to do Pilates on a reformer twice a week and there are many days where all I can do is just go stretch out because my body is so tired. If there is an event (visit with grandkids, wedding, or such) I power through, but it takes days to recover. Is this normal because of ITP?? Side effect of the Promacta?? How am I suppose to know why I am feeling this way?? I am getting quite discouraged.