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Changing trends in the UK management of childhood ITP
John D Grainger1, Joanne L Rees, Marie Reeves
1The University of Manchester, Manchester Academic Health Science Centre, Royal Manchester Children's Hospital, Manchester M13 9WL, UK. john.grainger@cmft.nhs.uk
Insights
UK doctors are treating fewer children with immune thrombocytopenia (ITP). Current UK treatment rates are significantly lower than historical and international practices for this childhood blood disorder.
Area of Science:
- Pediatric Hematology
- Clinical Research
- Public Health
Background:
- Childhood immune thrombocytopenia (ITP) is an autoimmune bleeding disorder.
- Treatment practices for ITP have evolved over time.
- Variations in treatment approaches exist globally.
Purpose of the Study:
- To compare current UK treatment practices for childhood ITP with historical UK data.
- To assess the trends in ITP management in the UK.
- To benchmark UK treatment against international standards.
Main Methods:
- Data collected via the national UK Childhood ITP registry (established 2007).
- Analysis included 225 children diagnosed with acute ITP.
- Outcomes measured: bleeding severity, platelet count, management, and 6-month follow-up.
Main Results:
- Treatment rates for childhood ITP in the UK decreased from 61% (1995) to 16% (2009).
- Current UK treatment rates are substantially lower than historical international data (69%).
- Most children presented with mild to moderate disease, with low rates of severe bleeding.
Conclusions:
- UK pediatric ITP management has shifted towards reduced intervention.
- Current UK treatment aligns with a trend of conservative management.
- This study highlights a significant divergence from historical and international treatment norms.
Objective:
To compare the treatment of childhood immune thrombocytopenia (ITP) with historical practice in the UK.
Design:
Data collection through a national UK Childhood ITP registry (http://www.uk-itp.org) started in January 2007.
Settings:
UK hospitals.
Participants:
Children admitted with a new diagnosis of acute ITP and their treating physicians.
Main Outcome Measures:
Bleeding severity, platelet count, disease management and outcome from the time of presentation to 6 months.
Results:
Data from 225 children were analysed. 54% of children had clinically mild, 42% had moderate and 4% had severe disease as defined previously. The mean platelet counts at diagnosis for these groups were 14, 8 and 6×10(9)/l respectively. Children with mild disease had fewer bleeding sites (1.9), compared with moderate (2.5) or severe disease (3.6). There was one intracranial haemorrhage reported. At 6 months' follow-up, 32% had a persistent platelet count <150×10(9)/l, but only 4.8% had a count <20. The proportion of UK children receiving platelet-raising treatment was noted to decrease from 61% in 1995 to 38% in 2000. The current UK 2009 registry data show a continued decrease in treatment to 16% of all the children. In contrast, historical international data report 69% of children receiving interventional therapy.
Conclusion:
The current UK practice has shown a continued reduction in the number of children receiving treatment in comparison with historical data and international practice.
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