Summary
Immune thrombocytopenia in children is usually a self-limiting illness, but in adults
the disease is likely to be chronic, and may be associated with other pathology which
predisposes to bleeding. Despite very low platelet counts serious bleeding is rare
in both adults and children. More than 80% of children have mild clinical manifestations.
Intracranial haemorrhage is rare at all ages, is unpredictable and can occur at any
time when the count is very low. Currently recommended therapies for both adults and
children are associated with significant side effects and occasional deaths. Treatment
may interfere with quality of life more than the illness itself. Drugs can be withheld
in the majority of children with appropriate advice to child and family. Treatment
can be individualised, taking into account the person’s needs and lifestyle as well
as bleeding. In chronic ITP many need no active therapy. The situation with adults
is more complex but those with a platelet count above 30 x 109/l usually need no treatment as bleeding is rare, and those adults with refractory
ITP unresponsive to treatment live with very low counts for years without significant
bleeding suggesting the need to re-evaluate the balance of risks of treatment versus
bleeding. It is notable that adults with ITP may die from infection, probably related
to therapy.
Keywords
ITP - thrombocytopenia
