Pediatric Immune Thrombocytopenia Does Not Overlap with Adult ITP
Immune thrombocytopenia (ITP) is a highly heterogeneous disease characterized by various bleeding manifestations and different needs for treatment or likelihood of remission. The difference is accentuated in terms of the disease course between children and adult patients.
Introduction
ITP is one of the most common bleeding disorders. It occurs in approximately 5–10/100,000 children and 3.3/100,000 adults annually. The pathophysiology of ITP is not entirely known, but it is believed that autoreactive antibodies play a key role. Their action leads to the destruction of blood platelets and disruption of megakaryopoiesis and platelet production.
Traditionally, differences have been observed between the course of ITP in children and adults:
Regarding epidemiology, adult ITP is characterized by a female predominance and the presence of comorbidities (diabetes, gastrointestinal difficulties, hypertension, thyroid disease, etc.).
A significant difference is observed especially in the likelihood of achieving spontaneous remission. ITP in childhood often has an acute course with a shorter time to remission. However, in chronic ITP, the disease course in children and adults is more similar, including the likelihood of achieving spontaneous remission.
Treatment Options
Treatment of ITP in childhood also represents a different approach. Experience has shown that observation (the watch and wait strategy) is a fully legitimate and recommended approach for many children with newly diagnosed ITP. The decision largely depends on the degree of bleeding manifestations. Even for children with a low platelet count but minimal or no bleeding symptoms, careful monitoring allows outpatient waiting to see if a spontaneous rise in platelet count occurs. These recommendations stem from observations that the likelihood of significant bleeding is low in such children.
If there is a decision to actively treat a child with acute ITP, immunoglobulins or corticosteroids are recommended as first-line therapies. In the second line, TPO mimetics, rituximab, and a wide range of immunosuppressants are used with very good effects.
Conclusion
ITP in childhood is a relatively common disease, particularly in younger ages, with a very good prognosis and high likelihood of remission. Since spontaneous remission of ITP often occurs, it is possible to wait with children showing minimal or no bleeding symptoms. However, research indicates that pediatric ITP is a heterogeneous disease, and especially in older children and teenagers, its course is much more similar to that of adult ITP.
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Source: Despotovic J. M., Grimes A. B. Pediatric ITP: is it different from adult ITP? Hematology Am Soc Hematol Educ Program 2018; 2018 (1): 405–411, doi: 10.1182/asheducation-2018.1.405.
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