[Immune thrombocytopenia in childhood--how much diagnosis and therapy is reasonable?]

Acute and chronic ITP in childhood are both relatively mild diseases that only rarely result in live threatening complications. In most cases diagnostic measures can be limited to a detailed history, thorough physical examination, a complete blood count and evaluation of platelet size on smear. A bone marrow aspirate is only necessary if the diagnosis of ITP is not straightforward. Because of large platelet size and vascular stability bleeding tendency in childhood ITP is mild even with very low platelet counts. 90% of children with acute IPT recover spontaneously within 12 months. Therefore therapy can safely be limited to a few situations: necessary surgical intervention during thrombocytopenia, live threatening bleeding, major trauma. In most instances optimal management of ITP consists in a "wait and see" approach in addition to giving detailed and thorough information to patients or parents about the benign nature of the disease, the likelihood of spontaneous recovery and the importance of avoiding aspirin and contact sports. Controversies in regards to diagnosis and therapy of ITP in childhood are discussed and the various therapeutic possibilities are presented.