Childhood immune thrombocytopenia: A nationwide cohort study on condition management and outcomes

Abstract

In routine clinical practice, the decision to apply a watchful waiting strategy seems to be driven by platelet counts even in the absence of bleeding symptoms, resulting in treatment being initiated in more than 80% of the children surveyed. Overall, younger children with ITP showed good prognosis, with lower platelet counts and, to a lesser extent, male gender predicting more favorable outcomes.

Retrospective evaluation of children with immune thrombocytopenic purpura and factors contributing to chronicity

“…The findings were in accordance with the literature and supported the fact that ITP had a good prognosis in children. 16,21,22 The remission rate within the first 6 months for childhood ITP was reported to be from 68 to 76%, and the chronicity was observed in 20e30% of cases, while 3e5% of patients demonstrated a recurrent course in acute ITP. 3e5, 10,12,14 Seventy-two percent of our patients had a acute pattern.…”

Updated international consensus report on the investigation and management of primary immune thrombocytopenia

“…243 SPECIAL DIAGNOSTIC CONSIDERATIONS IN CHILDREN. Older children and those with slow evolution of disease (evidence level Ib-III) 5,[244][245][246] may be more likely to develop chronic disease. Other autoimmune diseases associated with thrombocytopenia, including SLE, CVID, autoimmune lymphoproliferative syndrome, and chronic viral infections, should be considered in difficult, persistent, and chronic cases and in those with multiple autoimmune cytopenias (eg, Evans syndrome).…”

“…From registry and cohort data, 0% to 4% of children with newly diagnosed ITP have severe (grade 4) bleeding requiring immediate intervention (evidence level III) 245,250 ; bleeding that may require treatment is reported in 30% to 56% of newly diagnosed children (evidence level IIb-III). 245,250,251 The incidence of ICH in children with ITP is ;0% to 1% (evidence level III), 245,250,[252][253][254][255][256] and predicting with confidence which children will develop an ICH is very imperfect. Risk factors for ICH include low platelet count, 252 head trauma, 252 signs of other bleeding (especially grade 3 and macroscopic hematuria), and possibly other less well-documented factors, including NSAIDs and arteriovenous malformation.…”

Thrombocytopenia – a challenge for Pediatric Emergency Departments

“…Warrier R. and Chauhan A. state, in a review about ITP, that "the factors that influence the selection of a treatment regime in a given patient are quality of life impact, adverse events, the likelihood of response, bleeding risk, patient/parent anxiety, and economic issues" (9). Recent recommendations regarding the treatment of patients with ITP state that patients with no bleeding or mild bleeding (only skin manifestations like petechiae or ecchymosis) can be managed with only observation without any treatment, regardless of the platelet count (10,11). It is a difficult decision to make in the Emergency Department.…”