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 discuss with your consultant.
It is best not to take any holidays abroad in the first three months of ITP as it may be difficult to get insurance. After this time most cases of ITP will have resolved. If the ITP does persist you will need to discuss further with your doctor and you will need specialist medical insurance. A list of recommended insurance companies can be obtained from ITP Support Association (details below)
What else can I do?
Your child should also avoid drugs like aspirin, ibuprofen (calprofen) or herbal medication which can increase the risk of bruising and bleeding. Finally, you should make sure that doctors and dentists know that your child has a low platelet count if they are due to have an operation.
When to seek help?
When your child is sent home you will be given a clinic appointment for review at the hospital and an emergency number (usually the phone number to the children’s ward). You should contact the hospital in the following circumstances:
- A prolonged (over 30 minutes) nosebleed which will not stop despite pinching the nose
- Prolonged gum bleeding
- Blood in the poo or urine
- Following a heavy blow to the head, particularly if the child is stunned or sickly
- Persistent or severe headache
- Vomiting or drowsiness
- Children on steroids are at a greater risk of a severe form of chickenpox. If your child has not had chicken pox then contact the hospital If your child is in direct contact with someone who has chicken pox or who develops chickenpox within 7 days of being with your child.
Is there a UK registry?
To maintain accurate numbers of cases of childhood ITP and investigate possible markers for risk of severe bleeding a UK registry has been established (www.uk-itp.org) Families may be routinely asked to consent for anonymous data to be stored on the registry.
Further reading: The ITP Support Association produces the following booklets available free of charge to members.
- An illustrated booklet to help young children understand ITP. In 2 versions, James tells his story and 