According to the International Consensus Report guidelines, when is treatment indicated 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 when to start initial treatment in children newly diagnosed with ITP are as follows:

  • Any severe (grade 4) bleeding requires immediate hospital admission and treatment to increase platelet levels until bleeding has decreased.
  • Any moderate (grade 3) bleeding requires hospital review and consideration for admission and therapy.

Administer treatment and strongly consider hospitalization in the following cases:

  • Worsening bleeding or significant comorbidities
  • Risk of ICH (eg, head trauma or unexplained headaches); patients at higher risk for ICH include those with a history of moderate or severe bleed in the preceding 28 days, recent administration (within 8 hours) of NSAIDs, and another clinically significant coagulopathy (eg, von Willebrand disease). In the case of head trauma, treatment should precede a head computed tomography scan.
  • A change in behavior or mood consistent with significant depression or irritability
  • Parents are anxious about bleeding and do not believe that they can control (young child) or restrict (older child) their child’s activity.
  • Parents cannot be relied upon to bring the child back readily if there is an emergency (eg, they live too far away, they cannot afford to return, there are additional social concerns).
  • Child has not spontaneously improved and must be overly restricted in activities.
  • Child needs to take an anticoagulant or antiplatelet agent.
  • Higher risk of bleeding due to another medical or psychological issue

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