Acute immune thrombocytopenia (ITP) in childhood: Retrospective and prospective survey in Germany

Treatment of acute childhood immune thrombocytopenia (ITP) is controversial . For information on the present situation in Germany, a retrospective and a prospective survey were carried out. Tn the retrospective survey, questio nnaires were sent to all German pediatric hospitals asking about local poli cies for handling ITP and whether in the preceding year (starting on Octobe r 1995) death or ICH had occurred; 86% answered. In the prospective survey, 94% responded to the mailings ("have you seen a case of ITP?") sent in mon thly intervals between October 1, 1996 and September 30, 1997; 89% of the q uestionnaires were retrieved. In the retrospective survey, no deaths and no ICH were reported. If only mild bleedings, such as skin bleeds alone (or a dditional. mild mucous membrane bleeding) were present, 20.5% (26.4%) prefe rred the "watchful waiting" regimen (supportive care), irrespective of the platelet count; 79.5% (73.6%) would treat if the platelet counts were <5 X 10(9)/L, 73.5% (67.9%) if < 10, 35.9% (33.6%) if < 20, and 4.2% (2.6%) if < 30. Of the treaters, 50.5% would prefer immunoglobulins (Ig), 24.4% glucoc orticosteroids (GC), and 20.5% GC and/or Ig. Generally, a rise in platelets , most frequently > 50 X 10(9)/L was considered as therapeutic success. In the prospective survey, from the reported 323 children an annual incidence of 2.16 per 100,000 children was calculated. The incidence depended on age and gender, being highest for boys younger than 2 years with 5.8 (girls 3.4 2) and low with 0.44 for boys (girls 0.89) older than 14 years. About 60% o f the patients had a preceding infection. Although 83% had a platelet count < 20 X 10(9)/L (56% < 10 x 10(9)/L), almost all (97.5%) had only mild blee ding symptoms; 2.5% had serious bleeding symptoms requiring blood transfusi on or nasal packing, none had ICH, and no death was reported. The mean plat elet count on admission was 11.348 (lowest count 8.253) X 10(9)/L. Sixty-on e percent received Ig, 19% GC (both either alone or as first choice), 6% Ig plus GC, and 14% no treatment. Side effects were reported in 22% of the ch ildren treated with Ig. The retrospective survey mirrored the uncertainty i n regard to treatment. The prospective survey provided new aspects on incid ence, age, and gender distribution. Although almost all patients had only m ild bleeding; symptoms, most received Ig and/or GC. The decision to treat d epended mainly on the platelet count. From these surveys, conclusions about the effectiveness of treatment cannot be drawn. Recommendations based prim arily on platelet counts must be reconsidered.