Immune thrombocytopenic purpura in children. Diagnosis, treatment and controversies [Immunthrombozytopenische purpura bei kindern: Diagnostik, therapie und kontroversen]

Immune thrombocytopenic purpura is the commonest acquired haematological pathology. It is found in previously healthy children and generally has a benign course (remission in >80%). The acute form can be attributed to a previous virus infection with platelet-specific antibodies and resultant premature destruction of antibody-loaded thrombocytes in the reticulo endothelial system in about 60% of cases. In about 20% of affected children the thrombocytopenia persists for >6 months. The clinical course is variable and there are no uniformly present clinical characteristics, which makes it difficult to decide in individual cases whether the condition should be treated and, if so, what treatment should be selected. Treatments with corticosteroids, i.v. immunoglobulins, of i.v. anti-D-immunoglobulins are the most usual. Most doctors base their treatment of these children on the absolute thrombocyte count (< 20×109 1-1), regardless of the clinical symptoms observed. They are guided in this by their fear of a possible life-threatening haemorrhage, although the risk of intracranial haemorrhage is only 0.1-0.9% and it has not yet been uniquivocally demonstrated that immediate induction therapy is beneficial when there are no relevant symptoms of bleeding.