Immune thrombocytopenia (ITP) in children: Clinical features and diagnosis
- James B Bussel, MD
James B Bussel, MD
- Emeritus 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, but it can be triggered by a viral infection or other immunologic or environmental 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", while acknowledging the immune-mediated mechanism of the disorder and that patients may have little or no signs of purpura or bleeding .
The clinical features and diagnosis of ITP in children will be reviewed here. The initial treatment and management of chronic ITP in children are discussed separately. (See "Immune thrombocytopenia (ITP) in children: Initial management" and "Immune thrombocytopenia (ITP) in children: Management of chronic disease".)
The following terms are used throughout 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 outlined briefly below. (See 'Differential diagnosis' below.)
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- CLINICAL FEATURES
- Preceding illness or vaccination
- Lack of systemic signs and symptoms
- Bleeding symptoms
- - Grading of severity
- - Mucocutaneous bleeding
- - Serious hemorrhage
- Intracranial hemorrhage
- Laboratory findings
- Initial evaluation
- Further evaluation
- Indications for bone marrow examination
- No role for antiplatelet antibody testing
- DIFFERENTIAL DIAGNOSIS
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS