Thrombocytopenia In Children

Thrombocytopenia is a platelet count below 150 × 10⁹/L. Clinically important bleeding risk depends on platelet count, platelet function and the underlying disease.

Mechanisms include decreased production, immune destruction, consumption, sequestration and dilution.

• Petechiae
• Purpura
• Easy bruising
• Epistaxis
• Gingival bleeding
• Menorrhagia in adolescents

Severe disease may cause gastrointestinal, genitourinary or intracranial bleeding.

Hepatosplenomegaly, bone pain, lymphadenopathy or systemic illness suggests a diagnosis other than uncomplicated immune thrombocytopenia.

• Repeat FBC to exclude laboratory artefact.

• Review peripheral blood film.

• Determine whether thrombocytopenia is isolated or associated with anaemia or neutropenia.

• Consider coagulation profile, liver function, infection testing and bone marrow assessment according to presentation.

Treatment depends entirely on cause and bleeding severity.

Avoid IM injections and unnecessary NSAIDs in marked thrombocytopenia.

Platelet transfusion is not based on platelet count alone. It is indicated for major bleeding, selected extremely low counts with substantial risk, or before certain invasive procedures.

Do not routinely transfuse platelets in immune thrombocytopenia without major bleeding because transfused platelets are rapidly destroyed.