n 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 children (about 85% of children). WinRho is similar to immunoglobulin in producing antibodies which the immune system targets rather than the platelets. Anti-D is also a blood product but produced from a small number of donors. A small drop in the haemoglobin is common, rarely (1 in 40000 recipients) a severe and dangerous drop in the haemoglobin is seen. Anti-D can be given as a day case over about ten minutes and the benefit may last for several weeks.
In ITP the majority of platelets are destroyed in the spleen. Removing the spleen (splenectomy) is often effective in preventing early destruction of the platelets and allows the count to rise. In children however this is rarely necessary unless the ITP persists and the child has recurrent severe bleeds. Splenectomy is a major surgical procedure and carries a long term risk of severe infection.
What about school, sport and holidays?
Most severe bleeds tend to occur in the first week and in children with a platelet count under 20. In those children with a count over 20 they can return to school immediately after the head teacher has been informed about the ITP. In children with a lower platelet count school can resume after the first week and when the school have been informed. For primary school aged children it may be best if they take breaks inside if these can not be supervised. The ITP Support Association produces a document for schools, clubs and playgroups.
If your child is on steroids and has not had chicken pox then school will need to inform you if anyone in your child’s class/nursery comes down with chicken pox.
At home it is best to take sensible precautions which all children should follow such only cycling with a helmet and if swimming no diving into the shallow end! It is sensible to avoid sports where there is a risk of head injury whilst the platelet count is below 50 x109/l. Make sure any sports teachers are aware. With a platelet count between 50 and 100 there will still be more bruising so encourage the use of shin pads etc. For further details