Management of immune thrombocytopenic purpura

Childhood immune thrombocytopenic purpura (ITP) is an uncommon, generally self-limiting, heterogeneous condition usually with a good outlook. Most children recover quickly without serious bleeding complications irrespective of specific treatment to raise the platelet count. The low platelet count was thought to equate to a risk of serious bleeding, but several population studies have confirmed that this risk is low, around 3-4%, and intracranial haemorrhage is rare. Most children do not require active treatment. Assessment of bleeding by a clinical score is required together with assessment of quality of life issues that help to determine whether invasive investigations and treatment are worse for the child than the illness itself. Advances have been made in understanding the pathogenesis, and new treatments have been developed, some of which have been tried with success in children.