What are the International Consensus Report recommendations for treatment of children with chronic 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

Treatment of persistent or chronic ITP:

  • Most children with persistent or chronic ITP can be managed with watchful waiting. If an acute bleeding episode occurs, rescue therapy with corticosteroids, IVIG, and/or IV anti-D can be used.
  • Children who are having frequent or severe bleeding episodes or impaired HRQoL (including reduction in important activities) require referral to a hematologist experienced in treating pediatric ITP.
  • TPO-RAs often produce a good response and reduction in bleeding frequency, with an absence of adverse effects in the majority of patients. If the patient does not respond to a TPO-RA or loses response, switch to an alternative TPO-RA and/or consider combining with MMF or another immunosuppressant.
  • Consider rituximab and dexamethasone for patients, especially adolescent girls, in whom TPO-RAs fail.

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