What are the ASH guidelines on the treatment of immune thrombocytopenia (ITP) in children?

Updated: Dec 14, 2019
  • Author: Michael A Silverman, MD, MD; Chief Editor: Gil Z Shlamovitz, MD, FACEP  more...
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ASH has moved away from recommending treatment on the basis of the platelet count. The 2019 ASH guidelines recommend that children with no bleeding or mild bleeding (ie, skin manifestations only, such as bruising and petechiae) be managed with observation alone regardless of platelet count. [7]

ASH suggestions include the following for children with non–life-threatening mucosal bleeding and/or diminished health-related quality of life (HRQoL) [7] :

  • A short course of corticosteroids over anti-D immunoglobulin or IVIG for first-line treatment 
  • Thrombopoietin receptor agonists (TPO-RAs) over rituximab or splenectomy for second-line treatment
  • Rituximab over splenectomy for second-line treatment

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