IMMUNOTHROMBOCYTOPENIA IN CHILDHOOD - WHI CH DIAGNOSTIC-TEST AND HOW MUCH THERAPY IS REASONABLE

Acute and chronic ITP in childhood are both relatively mild diseases t hat only rarely result in live threatening complications. In most case s diagnostic measures can be Limited to a detailed history, thorough p hysical examination, a complete blood count and evaluation of platelet size on smear. A bone marrow aspirate is only necessary if the diagno sis of ITP is not straightforward. Because of large platelet size and vascular stability bleeding tendency in childhood ITP is mild even wit h very low platelet counts. 90% of children with acute IPT recover spo ntaneously within 12 months. Therefore therapy can savely be limited t o a few situations: necessary surgical intervention during thrombocyto penia, live threatening bleeding, major trauma. In most instances opti mal management of ITP consists in a ''wait and see'' approach in addit ion to giving detailed and thorough information to patients or parents about the benign nature of the disease, the likelihood of spontaneous recovery and the importance of avoiding aspirin and contact sports. C ontroversies in regards to diagnosis and therapy of ITP in childhood a re discussed and the various therapeutic possibilities are presented.