oreign and attacking the platelets. In many cases this may follow a viral infection or vaccination during which time the immune system attacks the virus but the immune system then goes on to think that the platelets are viral material and starts to attack the platelets.
How is ITP diagnosed?
ITP is usually diagnosed using a blood test called a ‘full blood count’. When a sample of your child’s blood is examined under a microscope, a haematologist can examine each blood cell type closely. This is to rule out other conditions that may cause similar symptoms to ITP. If the platelets, red blood cells and white blood cells all look normal, this rules out leukaemia. If the low platelet count improves quickly and no treatment is needed, your child will not need any further tests.
If the platelet count is not showing signs of recovery by 3 to 6 months then a small sample of bone marrow will need to be taken and examined under the microscope. Additional blood tests may be taken at this time to exclude rare clotting or immune diseases that can mimic ITP. If the bone marrow looks normal, with the usual or higher number of platelet parent cells (megakaryocytes) and other blood tests are normal then the doctor will diagnose chronic ITP.
What is the outlook for children with ITP?
Many children, particularly younger ones, suddenly improve within six weeks, whether or not treatment has been given. Three out of four children will have improved by 6 months after the start of ITP. Even those who fail to recover completely will reach a platelet count over 20 and have fewer bleeding problems. After six months about 25% of children will fully recover over the following year and over half will recover over several years.
When ITP recovers about one in 20 children will have a further occurrence in the future.
How is ITP treated?
Most children do not need any treatment unless they have severe bleeding, and most children improve whether or not treatment is given. The type of treatment recommended depends on your child’s symptoms rather than their platelet count. All the various forms of treatment aim to temporarily improve the platelet count and do not cure the condition itself. When treatments are considered, you will have the chance to discuss the risks and benefits of these, as opposed to no treatment, with the doctor. The options for treating ITP include:
1) No treatment
The majority of children with ITP have a low platelet count but do not have dangerous bleeding. If severe bleeding is not present at the time of diagnosis then it is very rare for dangerous bleeding to develop later. Without treatment most children will have a platelet count over 20 within 5 days and a normal platelet count by six months.
2) Tranexamic acid
Tranexamic acid does not increase the platelet count but does help the blood to produce clots. It is particularly useful for gum bleeds, nose bleeds or heavy periods and helps the blood to form clots without altering the platelet count. It is best taken as a liquid ("swish and swallow") three times per day. It most not be used if there is any blood in the urine.
3) Steroid treatment
Steroids are sometimes given to children with ITP on a short-term basis in an attempt to increase their platelet count. However, when the steroid dose is reduced, the platelet count will drop again after a few days. Steroids should only be given for a short period of between 4 to 7 days. Side effects such as weight gain and mood changes are common. Longer courses of steroids may dampen the immune system, weaken bones, cause diabetes or obesity and stunt growth.
3) Intravenous immunoglobulin
Immunoglobulins are antibodies which can reduce platelet destruction. They are a blood product produced from many donors and have a theoretical but very low risk of transmitting blood-borne infections. One course of treatment with immunoglobulin takes two to five days as an in-patient in the hospital and the benefit will usually last about a month. Side effects such as fever and headaches are common.
4) Anti – D (WinRho)
WinRho can be used in Rhesus positive 