Commentary on session: Immune thrombocytopenia nomenclature, guidelines, and natural history

Two presentations discussed different aspects of immune thrombocytopenia (ITP) management. The first considered active monitoring for occult hemorrhage in the gastrointestinal tract, urinary tract, and brain. Participants generally did not feel that these would be useful in determining management of children with ITP since serious bleeding was likely to manifest itself. A single historical paper had suggested that microscopic cranial bleeding may result in chronic brain disturbance, but overall experience of ITP does not support this. Participants considered ways of studying this possibility but noted the considerable difficulties in setting up a formal study and suggested that the established registries should be alerted to capture long-term data on school performance. The second presentation focused on the extent to which recent papers are using the new terminology and guidelines. Participants noted the two new guidelines gave discrepant advice with regard to splenectomy. Management of ITP is not necessarily straightforward and needs to be tailored to the individual.