What are treatment options for acute immune thrombocytopenic purpura (ITP) platelet disorder in children?

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

Answer

Treatment options include intravenous immune globulin (IVIG) and corticosteroids, alone or in combination. In select cases, anti-D immunoglobulin may be used.

IVIG (0.8-1 g/kg for 2 d) results in a prompt rise in the platelet count, and this response confirms the diagnosis of acute ITP. The mechanisms of action of IVIG are not clear. Suggested mechanisms include blocking the macrophage Fc receptors, suppressing autoantibody production by providing anti-idiotypes, and stimulating the clearance of autoantibodies.

The adverse effects of IVIG include fever, nausea, vomiting, and, occasionally, renal failure. IVIG is also very expensive compared with prednisone and is not available in all countries.

Oral prednisone (4 mg/kg, with tapering and discontinuation by day 21) or IV methylprednisolone (30 mg/kg for 3 d) is also effective, although recovery is not as quick as with IVIG. The mode of action of prednisone is probably multifold, decreasing antibody production, increasing platelet formation, decreasing macrophage-mediated clearance of platelets in the spleen, and immunomodulating the immune response.

The combination of steroids and IVIG is synergistic and can be used in patients with imminent hemorrhage.

Inducing a mild hemolytic state by administering anti-D immunoglobulin (25-50 μg/kg for 2 d) is effective in individuals who are Rh positive, but is recommended only in those patients who have a negative direct antiglobulin test (DAT) and who have not undergone splenectomy. This therapy is less expensive than IVIG. However, the US Food and Drug Administration (FDA) has provided a warning and specific monitoring requirements because of reports of fatal intravascular hemolysis reported with anti-D immunoglobulin. [1]

With these modalities, the platelet counts in most children can be maintained at more than 30,000/µL until spontaneous remission occurs.

Other supportive measures include avoiding drugs that impair platelet function (eg, aspirin) and avoiding competitive contact sports.


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