Evidence-based clinical practice guideline for the management of primary immune thrombocytopenia (ITP) in pediatric population

Abstract

Introduction: Primary immune thrombocytopenia (ITP) is the most frequent cause of thrombocytopenia in pediatric population, with a reported incidence of 1.1-12.5 cases per 100 000 children. However, currently there are different definitions of ITP, as well as diagnostic and therapeutic approaches. Objective: To develop an evidence-based clinical practice guideline (CPG) to unify ITP definitions, and this way, reduce the variability of its diagnosis, and to provide indications for the treatment of acute, persistent, and chronic ITP in patients under 18 years of age Materials and methods: The CPG was developed by a multidisciplinary group that followed the standard methods of the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) guidelines for the development of CPGs, formulated PICO clinical questions, and conducted systematic reviews. GRADE evidence profiles were created and recommendations, with their respective level of evidence and strength, were made after a panel of experts assessed the benefit-risk balance, the quality of evidence, the patients’ values and preferences and the context in which they should be implemented. Results: A total of 23 recommendations for the treatment of acute, persistent and chronic ITP by pediatricians, hematologist and health professionals working in emergency services were made. Overall, the evidence of the GPC is of low quality and the recommendations were formulated in order to improve the treatment success rate of ITP and the prognosis of children with this condition. Conclusions: Despite ITP is the main cause of thrombocytopenia in pediatric population, so far there is not enough high quality evidence supporting the recommendations presented here for its proper classification and treatment in children. Thus, further studies providing high quality evidence on this issue are required.