Overview of ITP treatment modalities in children

Patients with idiopathic thrombocytopenia purpura (ITP) are frequently encountered by the pediatrician and pediatric hematologist. The clinical and laboratory features of ITP are quite uniform and facilitate prompt and accurate diagnosis. Bone marrow examination is not required in most cases since patients with alternative diagnoses (such as ALL) have greatly different presenting features. Acute ITP cannot be differentiated from the chronic form of the disease at presentation, nor can chronic disease be prevented by specific therapy administered for apparent acute ITP. Much controversy has revolved around whether an active interventionist (pharmacologic) or non-interventionist approach is preferred for management of ITP. The platelet count in both acute and chronic ITP often rises following treatment with prednisone and/or intravenous gamma globulin (IV GG), but such responses are transient and do not clearly provide protection against the rare complication of life-threatening hemorrhage. There are numerous disadvantages to an interventionist approach to therapy. Children with chronic ITP may require splenectomy if the disease is symptomatic enough to interfere with life-style, but the majority of these patients, too, require no specific therapy.