ABSTRACT
Treatment of acute childhood immune thrombocytopenia (ITP) is controversial. For information
on the present situation in Germany, a retrospective and a prospective survey were
carried out. In the retrospective survey, questionnaires were sent to all German pediatric
hospitals asking about local policies for handling ITP and whether in the preceding
year (starting on October 1995) death or ICH had occurred; 86% answered. In the prospective
survey, 94% responded to the mailings (``have you seen a case of ITP?'') sent in monthly
intervals between October 1, 1996 and September 30, 1997; 89% of the questionnaires
were retrieved. In the retrospective survey, no deaths and no ICH were reported. If
only mild bleedings, such as skin bleeds alone (or additional mild mucous membrane
bleeding) were present, 20.5% (26.4%) preferred the ``watchful waiting'' regimen (supportive
care), irrespective of the platelet count; 79.5% (73.6%) would treat if the platelet
counts were <5 × 109/L, 73.5% (67.9%) if < 10, 35.9% (33.6%) if < 20, and 4.2% (2.6%) if <30. Of the treaters,
50.5% would prefer immunoglobulins (Ig), 24.4% glucocorticosteroids (GC), and 20.5%
GC and/or Ig. Generally, a rise in platelets, most frequently >50 × 109/L was considered as therapeutic success. In the prospective survey, from the reported
323 children an annual incidence of 2.16 per 100,000 children was calculated. The
incidence depended on age and gender, being highest for boys younger than 2 years
with 5.8 (girls 3.42) and low with 0.44 for boys (girls 0.89) older than14 years.
About 60% of the patients had a preceding infection. Although 83% had a platelet count
<20 × 109/L (56% <10 × 109/L), almost all (97.5%) had only mild bleeding symptoms; 2.5% had serious bleeding
symptoms requiring blood transfusion or nasal packing, none had ICH, and no death
was reported. The mean platelet count on admission was 11.348 (lowest count 8.253)
× 109/L. Sixty-one percent received Ig, 19% GC (both either alone or as first choice),
6% Ig plus GC, and 14% no treatment. Side effects were reported in 22% of the children
treated with Ig. The retrospective survey mirrored the uncertainty in regard to treatment.
The prospective survey provided new aspects on incidence, age, and gender distribution.
Although almost all patients had only mild bleeding symptoms, most received Ig and/or
GC. The decision to treat depended mainly on the platelet count. From these surveys,
conclusions about the effectiveness of treatment cannot be drawn. Recommendations
based primarily on platelet counts must be reconsidered.
KEYWORD
Immune thrombocytopenia (ITP) - children - incidence - symptoms - platelet count -
treatment - side effects of treatment - survey
