Etiology, Clinical Presentation, and Management of Thrombocytopenia in Children (Immune Thrombocytopenia - ITP)

Introduction

Immune thrombocytopenia (ITP) is a hematologic disorder characterized by a low platelet count (<100,000/µL), resulting in an increased risk of bleeding. This condition is commonly observed in pediatric patients and can present as acute or chronic.

Etiology

ITP in children is primarily an autoimmune disorder. The body’s immune system mistakenly produces autoantibodies that target platelets, leading to their destruction by the spleen. It may be triggered by viral infections, vaccinations, or genetic predisposition.

Clinical Presentation

• Easy bruising and petechiae
• Epistaxis and mucosal bleeding
• Rare occurrences of intracranial hemorrhage

Management

The approach to management depends on the severity of thrombocytopenia and the presence of bleeding symptoms.

First-Line Treatment

• Observation for mild cases
• Corticosteroids (prednisone, dexamethasone)
• Intravenous immunoglobulin (IVIG) for severe thrombocytopenia

Second-Line Treatment

• Rituximab
• Thrombopoietin receptor agonists (eltrombopag, romiplostim)
• Splenectomy in refractory cases

Prognosis and Long-Term Outcomes

Most pediatric ITP cases resolve within six months. Chronic ITP may persist beyond this period, requiring long-term monitoring and treatment.

Complications

• Hemorrhagic complications
• Adverse effects from immunosuppressive therapy
• Psychosocial impact on children and families

Conclusion

Pediatric ITP remains a significant condition requiring individualized treatment strategies to minimize bleeding risks and improve the quality of life.