How is acute immune thrombocytopenic purpura (ITP) platelet disorder in children treated?

Updated: Aug 05, 2017
  • Author: Perumal Thiagarajan, MD; Chief Editor: Srikanth Nagalla, MBBS, MS, FACP  more...
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Answer

Answer

Because acute immune thrombocytopenic purpura (ITP) in children is self-limited, most physicians do not routinely treat it. Treatment is necessary only to prevent intracranial or other serious internal hemorrhage. [17] The rate of intracranial hemorrhage is very low, possibly less than 0.1%, and occurs with platelet counts of 10,000-20,000/µL.

Most physicians arbitrarily treat children with ITP when their platelet count levels are less than 20,000/µL. Nevertheless, current guidelines from the American Society of Hematology recommend that children with no bleeding or mild bleeding (defined as bruising and petechiae, with no mucosal bleeding) be managed with observation alone regardless of platelet count. [1]

The guidelines note, however, that "the decision to manage with observation alone requires a detailed discussion with the family about health-related quality of life, medication side effects and efficacy, and anticipatory guidance about preventing and monitoring for bleeding," and that individual circumstances, such as unreliable followup or distance from the hospital, may make treatment an appropriate choice. [1]


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