Self-reported diagnostic and management strategies in childhood idiopathicthrombocytopenic purpura: Results of a survey of practicing pediatric hematology/oncology specialists

Purpose: To assess current physician self-reported practices regarding init ial management of childhood idiopathic thrombocytopenic purpura (ITP) and t o determine physician self-reported willingness to participate in randomize d clinical trials comparing different initial management strategies. Patients and Methods: A questionnaire was mailed in November 1997 to all 72 0 members of the American Society of Pediatric Hematology/Oncology asking h ow they would diagnose and manage ITP in children 18 months, 5 years, and 1 5 years of age who were experiencing either dry purpura (cutaneous hemorrha ge only) or wet purpura (active mucous membrane hemorrhage). Specific quest ions dealt with bone marrow aspiration, hospital admittance, treatment stra tegy, and specific doses of corticosteroids and intravenous immunoglobulin. Results: The response rate to the questionnaire was 57%. Most respondents i ndicated they usually perform a bone marrow aspirate when corticosteroids a re to be prescribed and administer drug therapy to patients with newly diag nosed ITP with wet or dry purpura, Only 16% of respondents would administer no drug therapy to a child with dry purpura. Intravenous immunoglobulin (I VIG) was preferred to steroids, with anti-D immunoglobulin prescribed less frequently. Hospital admittance often was used for patients with dry purpur a and usually recommended for patients with wet purpura. Most respondents e xpressed willingness to randomize patients with dry purpura to IVIG versus no therapy and those with wet purpura to IVIG versus prednisone as part of a randomized controlled clinical trial. Conclusions: The self-reported care of the patient with ITP was influenced by the severity of presentation (dry versus wet purpura). Most physicians r eported they would administer specific drug treatment in both scenarios. Th is survey illustrates the diverse diagnostic and management strategies curr ently used in childhood ITP. Because no one therapeutic approach is predomi nant and a scientific basis for decision making in childhood ITP has not be en developed, future randomized trials are warranted. On the basis of these survey results, such trials are desired by most pediatric hematology/oncol ogy specialists.