In this section
ITP is an acquired thrombocytopenia due to immune mediated shortened circulating platelet survival in the absence of other disturbances of haemostasis or coagulation. In most childhood ITP platelet autoantibodies are absent.
Initial treatment options include no treatment and oral steroids.
Without active treatment, most patients platelet counts will return to a level at which normal activity can be recommenced within 4-6 weeks. Oral steroids bring up the platelet count more quickly than occurs spontaneously but there is no evidence for an
effect on significant morbidity, risk of chronic ITP, or mortality.
At RCH, the on-call General Paediatric
consultant is responsible for deciding on the treatment
Most patients with a platelet count > 20 x 109/l and some of those with a platelet count
< 20 x 109/l can be managed as outpatients with no specific treatment. The following criteria must be met:
In some cases, thrombocytopenia will redevelop months or years after the first episode has resolved. These relapses or recurrences are usually precipitated by viral infections. Provided the first episode remitted spontaneously without complication and the patient
has been well with a documented normal platelet count between episodes, these cases can be managed as for acute ITP.
Ongoing thrombocytopenia after a 6 month period denotes chronic ITP. A history of bruising from infancy should prompt suspicion of one of the rare congenital thrombocytopenias. Careful inspection of the blood film and tests of platelet function will serve to exclude
other diagnoses. Bone marrow examination may behelpful in confirming chronic ITP.
Rarely, splenectomy is required (success rate 70-80%).
ITP Parent Information Sheet (HTML version)
Parent Information Sheet