Changes in chilhood ITP treatment and follow-up in 2011

Abstract

Immune thrombocytopenic purpura (ITP) is the most frequent hemorrhagic disease in children. The shortened life of platelets because of immunologic damage (antibodies absorbed by platelets) and insufficient compensatory increased function of the bone marrow result with reduced number of platelets in the peripheral blood. There are three forms of ITP: acute, chronic and persistent. The acute form occurs in 80-90% of cases with bleeding episodes lasting a few days or weeks, but no longer than 6 months, the new 2011 American Society of Hematology guideline increased this period to one year. It is typical for the phenomenon of bleeding that it starts suddenly and without any other sign of illness. The most frequent acute form appears between the second and fourth year, and is occurrence usually after acute viral infections. Children older than 10 years of age, like adults, often have the chronic form associated with other immunologic disorders. Hemorrhagic manifestations include: petechiae, purpura, epistaxis, gastrointestinal and genitourinary bleeding. They depend on the grade of thrombocytopenia, although there is no strict correlation between the number of platelets and volume of bleeding. In cases of acute ITP in children, usually there are two therapeutic options or therapies of choice: corticosteroids and high doses of intravenous immunoglobulin. There are also immunosupressive therapy, anti Rh(D) immunoglobulin, cyclosporine, cytostatics, danazol, rituximab, and thrombopoietin receptor agonists. In cases of distinctive hemorrhagic syndrome there are also indications for platelet transfusion. Nowadays splenectomy is more restricted, because one third of cases is unsuccessful. (Turk Arch Ped 2012; 47:8-16)