What are the International Consensus Report recommendations for watch-and -wait in children with immune thrombocytopenia (ITP)?

Updated: Jan 11, 2020
  • Author: Craig M Kessler, MD, MACP; Chief Editor: Srikanth Nagalla, MBBS, MS, FACP  more...
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Answer

Recommendations for a watch-and-wait policy, based on clinical classification, are as follows:

  • At diagnosis, children and adolescents with ITP and mild or even moderate bleeding on a pediatric bleeding assessment tool (grade 1-3) may be managed expectantly with supportive advice and a 24-hour contact point, irrespective of platelet count
  • Those with grade 3 bleeding are more likely to require therapy because of the higher rates of serious bleeding requiring hospital admission and emergency treatment.
  • All patients need regular reevaluation to monitor for worsening, including health-related quality of life (HRQoL) and evolution to a serious bone marrow disorder or a secondary form of ITP. The frequency of clinical and laboratory monitoring should be based on bleeding, HRQoL, trend in platelet counts, and impression of family reliability.
  • The same monitoring and 24-hour access are needed with persistent and chronic ITP, depending upon the factors listed above, but at less frequent intervals in a stable patient. Observation or watch-and-wait is less validated in patients with persistent and chronic ITP because it is based on the expectation of spontaneous future improvement.

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