Thrombocytopenia in Children

Management Strategies and Treatment Options for Pediatric ITP

Thrombocytopenia, a condition characterized by low platelet count, can pose significant challenges in pediatric patients. Immune thrombocytopenia (ITP) is one of the primary causes of thrombocytopenia in children, leading to an increased risk of bleeding and complications.

Understanding Pediatric ITP

Pediatric ITP is an autoimmune disorder in which the body's immune system mistakenly targets and destroys platelets. While often self-limiting, chronic cases require medical intervention.

Diagnosis and Evaluation

• Complete blood count (CBC) to confirm thrombocytopenia
• Peripheral blood smear to assess platelet morphology
• Bone marrow biopsy if secondary causes are suspected

Treatment Strategies

Management of pediatric ITP depends on the severity of thrombocytopenia and bleeding symptoms:

First-Line Therapies

• Observation for mild cases without significant bleeding
• Corticosteroids (Prednisone or Dexamethasone) to suppress immune-mediated platelet destruction
• Intravenous immunoglobulin (IVIG) for rapid platelet count improvement

Second-Line and Refractory Cases

• Rituximab as a monoclonal antibody targeting B-cells
• Thrombopoietin receptor agonists (Eltrombopag, Romiplostim) to boost platelet production
• Splenectomy in severe, refractory cases

Monitoring and Long-Term Outlook

Regular platelet count monitoring and bleeding risk assessment are crucial. Many children recover within six months, but chronic ITP may require extended therapy.