Immune thrombocytopenia (ITP) in children: Initial management
- James B Bussel, MD
James B Bussel, MD
- Professor of Pediatrics, Pediatric Hematology
- Weill Medical College of Cornell University
Immune thrombocytopenia (ITP) of childhood is characterized by isolated thrombocytopenia (platelet count <100,000/microL with normal white blood cell count and hemoglobin). The cause of ITP remains unknown in most cases, although it can be triggered by a viral infection or other immune trigger [1-3]. ITP was previously known as idiopathic thrombocytopenic purpura or immune thrombocytopenic purpura. The current term Immune ThrombocytoPenia preserves the widely-recognized acronym "ITP," and acknowledges the immune-mediated mechanism of the disorder, while allowing that patients may have little or no signs of purpura or bleeding .
The treatment and prognosis of newly diagnosed and persistent ITP in children will be reviewed here. The management of chronic ITP, and the clinical manifestations and diagnosis of ITP are discussed separately. (See "Immune thrombocytopenia (ITP) in children: Management of chronic disease" and "Immune thrombocytopenia (ITP) in children: Clinical features and diagnosis".)
The following terms are used in this topic:
●Primary ITP – ITP in the absence of other causes or disorders that may be associated with the thrombocytopenia is known as primary ITP, and is the main focus of this topic review.
●Secondary ITP – Secondary ITP refers to immune-mediated thrombocytopenia with an underlying cause, including drug-induced, or associated with systemic illness (eg, systemic lupus erythematosus, HIV). Secondary causes of immune-mediated thrombocytopenia are reviewed separately. (See "Immune thrombocytopenia (ITP) in children: Clinical features and diagnosis", section on 'Differential diagnosis' and "Causes of thrombocytopenia in children".)
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- General measures
- Treatment approach
- - Overview
- - Life-threatening bleeding
- - Severe non-life-threatening bleeding
- - High bleeding risk
- - Moderate bleeding risk
- - Low bleeding risk
- - Surgery/invasive procedures
- Target platelet count
- Response to treatment
- - Expected response
- - Poor response to initial therapy
- - Relapses
- FIRST-LINE THERAPIES
- Anti-D immune globulin
- SECOND-LINE THERAPIES
- Disease course
- Bleeding complications
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS