Update on the management of immune thrombocytopenic purpura in children.
OBJECTIVE
Since the publication of management guidelines from the American Society of Hematology (1996) and the British Committee for Standards in Haematology (2003), issues surrounding the diagnosis and treatment of immune thrombocytopenic purpura in children continue to evolve. Reports of the last decade are reviewed here.


RESULTS
Few data support a change in the diagnostic approach to childhood immune thrombocytopenic purpura. Recent publications have again challenged the need to treat minimally symptomatic children with severely low platelet counts and confirmed that anti-D immune globulin is a front-line treatment option. The management of chronic disease in children is essentially the same as in acute cases that become persistent or refractory to treatment. During the past 3 years, noncontrolled studies have suggested that rituximab may be useful for persistent disease. Elsewhere, encouraging evidence suggests that the effect of splenectomy for children is durable in the long term.


CONCLUSIONS
The decision to treat or only observe the minimally symptomatic child with severe thrombocytopenia remains controversial. This ongoing debate has served as a mandate to develop and implement clinical scoring and quality of life tools in treatment and clinical trial design. Meanwhile, experiences with adult cases have introduced new drug treatment options for children, especially those with chronic disease and significant bleeding.
Tarantino
Michael D
MD
Comprehensive Bleeding Disorders Center, Peoria, Illinois 61614, USA. mdtara@hemophilia-ctr-peoria.com
Bolton-Maggs
Paula Hb
PH
D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D005260:Female; D006405:Hematology; D006470:Hemorrhage / Q000175:diagnosis / Q000473:pathology / Q000628:therapy; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D008297:Male; D010976:Platelet Count; D017410:Practice Guidelines as Topic; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000175:diagnosis / Q000473:pathology / Q000628:therapy*; D011788:Quality of Life; D018029:Rho(D) Immune Globulin / Q000627:therapeutic use*; D000069283:Rituximab; D012720:Severity of Illness Index; D012955:Societies, Medical; D013156:Splenectomy; D006113:United Kingdom; D014481:United States
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D007155:Immunologic Factors; D018029:Rho(D) Immune Globulin; D000069283:Rituximab