Treatment strategy of childhood immune thrombocytopenia

Abstract

Immune thrombocytopenia (ITP) of childhood is the most common hemorrhagic disease which is characterized by isolated thrombocytopenia.Depending on individual patient characteristics, appropriate initial management for newly diagnosed ITP may be either watchful waiting or pharmacologic intervention.The main options for initial pharmacologic intervention include a single dose of intravenous immune globulin(IVIG)and/or a short course of glucocorticoids.For ITP children with severe or life-threatening bleeding, it is recommended that both platelet transfusions and the combination of pharmacotherapy.Approximately 20 percent of children who present with ITP will progress to chronic ITP(CITP). Children who develop CITP should have an additional evaluation to exclude other disorders.The pharmacologic options for CITP include Rituximab, and thrombopoietin (TPO)/TPO receptor agonist (Romiplostim or Eltrombopag). Combination therapy and novel immunological targeting drugs become more effective treatment options.Splenectomy is only suit for a small number of children with chronic refractory ITP patients who present significant and persistent hemorrhagic symptoms requiring repeated pharmacologic interventions. Key words: Immune thrombocytopenia; Treatment; Child