Acute childhood idiopathic thrombocytopenic purpura: AIEOP consensus guidelines for diagnosis and treatment

Background and Objectives. A recent evaluation carried auf by the Associazi one Italiana di Ematologia Oncologia Pediatrica (AIEOP) about practice mana gement of acute childhood idiopathic thrombocytopenic purpura (ITP) reveale d a remarkable difference of behaviors among the different AIEOP centers. A need for common practice guidelines for this frequent illness arose from t his observation. Our aim to make the diagnosis and treatment of childhood u niform. In the future we will evaluate the of these guidelines on practice behaviors. Data sources and Methods. Our main reference was 1996 document produced by the American Society of Hematology (ASH). Their recommendations were update d with Information from literature the MEDLINE database (June 1996-1998); s earch terms included: thrombocytopenia, ITP, diagnosis, therapy, children. The computerized search retrieved 83 articles. Data extraction: the scienti fic validity of the literature was evaluated by a panel of members using pu blished guidelines. The strength of the evidence was assessed using level o f evidence criteria. out Only data from level in account. Only one of the 8 3 retrieved articles met these selection considered in addition to the 11 o ut of 581 articles selected in the ASH ITP guidelines. This preliminary wor k pointed out each issue about ITP not addressed by clinical studies and al l participants in a Consensus Conference expressed their opinion about thes e Issues. Results. Diagnosis is essentially based on history, physical examination, a complete blood count and an examination of the peripheral blood smear. Tre atment is recommended is recommended taking into account the clinical pictu re and number of platelets. The main difference between these guidelines an d those from ASH are: AIEOP guidelines rely on the opinion of the members o f the consensus conference, ASH ones on a panel of experts; therapeutic opt ions include only products available in Italy; the indications to treatment rely more on clinical picture than on platelet number. Interpretation and Conclusions. These are explicitly developed, evidence-ba sed practice guidelines to assist Italian pediatricians in making decisions about diagnosis and appropriate health care for patients with acute childh ood ITP. (C) 2000, Ferrata Storti Foundation.