Immune Thrombocytopenia

Immune thrombocytopenia is acquired immune mediated platelet destruction resulting in isolated thrombocytopenia in an otherwise well child. It often follows viral infection and usually resolves spontaneously in children.

• Petechiae
• Purpura
• Easy bruising
• Epistaxis
• Oral mucosal bleeding

The child is usually otherwise well.

Fever, weight loss, lymphadenopathy, hepatosplenomegaly, bone pain or pancytopenia should prompt reconsideration for leukaemia, infection or marrow failure.

• FBC shows isolated thrombocytopenia.

• Blood film confirms reduced platelets and excludes blasts or other major abnormalities.

• Bone marrow examination is not routinely necessary in typical childhood ITP.

Management is driven primarily by bleeding severity rather than platelet count alone.

• Children with skin manifestations only and no significant mucosal bleeding can often be observed.

• When treatment is required, prednisolone approximately 2 to 4 mg/kg/day PO for a short course, often 4 to 7 days, is effective.

• Alternative for significant bleeding or need for rapid rise: IV immunoglobulin 0.8 to 1 g/kg IV once, repeat if necessary.

• Life threatening haemorrhage requires urgent combined therapy with IVIG, high dose corticosteroid and platelet transfusion, plus local haemostatic measures.