Idiopathic thrombocytopenic purpura in children


  • Jelena Roganović Department of Pediatrics, School of Medicine, University of Rijeka Head of the Division of Hematology and Oncology, University Children’s Hospital Rijeka, Rijeka


Idiopathic thrombocytopenic purpura, Child


Idiopathic thrombocytopenic purpura (ITP) is the most commonacquired bleeding disorder in childhood. ITP is characterizedby a low circulating platelet count caused principallyby destruction of antibody-coated platelets in the reticuloendothelialsystem. It can be classified into two major forms,acute and chronic. Acute ITP is usually a benign self-limitingcondition with a high probability of spontaneous recovery.Rates of 80% complete remission can be achieved regardlessof the treatment. Persistence of thrombocytopenia for morethan 6 months defines the chronic form of the disorder, and isseen in approximately 20% of children. Children with chronicITP also have a good prognosis, with up to 80% remissionsover a period of years following diagnosis. The variability ofclinical course makes the decision of whether and how to treatdifficult. Most children with ITP have mild bleeding symptomsand require no therapy. The commonly used regimensinclude corticosteroids and intravenous immunoglobulins. Sofar, there is no evidence that initial therapy can prevent majorbleeding or a chronic course of the disease. ITP in childhoodremains a disorder with many unsolved questions regardingpathophysiology, diagnostic approach and therapeutic decisions.Large prospective clinical trials with long-term followupare needed to define which subgroup of children with ITPshould be treated with platelet-enhancing therapy.


Download data is not yet available.


Harrington WJ, Minnich V, Hollingsworth JW, Moore CV. Demonstration of a thrombocytopenic factor in the blood of patients with thrombocytopenic purpura. J Lab Clin Med. 1951;38:1-10.

Shulman NR, Marder VJ, Weinrach RS. Similarities between known antiplatelet antibodies and the factor responsible for thrombocytopenia in idiopathic purpura. Physiologic, serologic and isotopic studies. Ann N Y Acad Sci. 1965;124:499-542.

Fogarty PF, Segal JB. The epidemiology of immune thrombocytopenic purpura. Curr Opin Hematol. 2007;14:515-9.

Nugent DJ. Immune thrombocytopenic purpura of childhood. Hematology Am Soc Hematol Educ Prog. 2006:97-103.

Gadner H. Management of immune thrombocytopenic purpura in children. Rev Clin Exp Hematol. 2001;5:201-21.

Wilson DB. Acquired platelet defects. In: Nathan DG, Ginsburg D, Orkin SH, Look TA, editors. Nathan and Oski’s Hematology of Infancy and Childhood. 6th ed. Philadelphia: W.B. Saunders

Company; 2003. p. 1597-630.

Kühne T. Idiopathic thrombocytopenic purpura of childhood: A problem-oriented review of the management. Transf Apher Sci. 2003;28:243-8.

George JN. Platelets. Lancet. 2000;355:1531-9.

Di Paola JA, Buchanan GR. Immune thrombocytopenic purpura. Pediatr Clin N Am. 2002;49:911-28.

Tomiyama Y, Kosugi S. Autoantigenic epitopes on platelet glycoproteins. Int J Hematol. 2005;8:100-5.

McMillan R. Autoantibodies and autoantigens in chronic immune thrombocytopenic purpura. Semin Hematol. 2000;37:5-9.

Blanchette V, Bolton-Maggs P. Childhood immune thrombocytopenic purpura: Diagnosis and management. Pediatr Clin N Am. 2008;55:393-420.

Semple JW. Immune pathophysiology of autoimmune thrombocytopenic purpura. Blood Rev. 2002;16:9-12.

Zhou B, Zhao H, Yang RC, Han ZC. Multi-dysfunctional pathophysiology in ITP. Crit Rev Oncol Hematol. 2005;54:107-16.

Carcao MD, Blanchette VS, Wakenfield CD, et al. Fcγ receptor IIa and IIIa polymorphisms in childhood immune thrombocytopenic purpura. Br J Haematol. 2003;120:135-41.

Roganović J. Idiopatska trombocitopenična purpura u djece. Pedijatrija danas. 2006;2:191-202.

Leung AKC, Chan KW. Evaluating the child with purpura. Am Fam Physician. 2001;64:419-28.

Kenet G, Lubetsky A, Shenkman B, Tamarin I, Dardik R, Rechavi G, et al. Cone and platelet analyser (CPA): A new test for the prediction of bleeding among thrombocytopenic patients. Br J Haematol. 1998;101:255-9.

Kühne T, Imbach P, Bolton-Maggs PHB, Berchtold W, Blanchette V, Buchanan GR, for Intercontinental Childhood ITP Study Group. Newly diagnosed idiopathic thrombocytopenic purpura in childhood: an observational study. Lancet.


Roganovic J, Letica-Crepulja M. Idiopathic thrombocytopenic puprura: a 15-year natural history study at the Children’s Hospital Rijeka, Croatia. Pediatr Blood Cancer. 2006;47:662-4.

Roganovic J, Letica-Crepulja M, Dordevic L. Recurrent immune thrombocytopenic purpura in children. Pediatr Hematol Oncol. 2008;25:243-4.

Imbach P, Kühne T, Müller D, Berchtold W, Zimmerman S, Elalfy M, et al. Childhood ITP: 12 months follow-up data prospective Registry I of the Intercontinental Childhood ITP Study Group (ICIS). Pediatr Blood Cancer. 2006;46:351-6.

Jayabose S, Levendoglu-Tugal O, Ozkaynkak MF, Visintainer P, Sandoval C. Long-term outcome of chronic idiopathic thrombocytopenic purpura in children. J Pediatr Hematol Oncol. 2004;26:724-6.

Butros JL, Bussel JB. Intracranial hemorrhage in immune thrombocytopenic purpura: a retrospective analysis. J Pediatr Hematol Oncol. 2003;25:660-4.

Roganovic J, Kalinyak K. Intracranial hemorrhage in children with chronic immunothrombocytopenic purpura. Pediatr Int. 2006;48:517.

Bolton-Maggs P. Severe bleeding in idiopathic thrombocytopenic purpura. J Pediatr Hematol Oncol. 2003;25(Suppl 1);S47-51.

Bolton-Maggs PHB, Moon I. Assesment of UK practice for management of acute childhood idiopathic thrombocytopenic purpura against published guidelines. Lancet. 1997;350:620-3.

Buchanan GR. Bleeding signs in children with idiopathic thrombocytopenic purpura. J Pediatr Hematol Oncol. 2003;25:42-6.

Buchanan GR, Adix L. Grading of hemorrhage in children with idiopathic thrombocytopenic purpura. J Pediatr. 2002;141:638-8.

Chu YW, Korb J, Sakamoto KM. Idiopathic thrombocytopenic purpura. Pediatr Rev. 2000;21:95-103.

Fabris F, Scalandellari R, Randi ML, Carraro G, Luzzatto G, Girolami A. Attempt to improve the diagnosis of immune thrombocytopenia by combined use of two different platelet autoantibodies assays (PAIgG and MACE). Haematologica. 2002;87:1046-52.

British Committee for Standards in Haematology General Haematology Task Force. Guidelines for the investigation and management of idiopathic thrombocytopenic purpura in adults, children and in pregnancy. Br J Haematol. 2003;120:574-96.

Kurtzberg J, Stockman JA 3rd. Idiopathic autoimmune thrombocytopenic purpura. Adv Pediatr. 1994;41:111-34.

Kaplan RN, Bussel JB. Differential diagnosis and management of thrombocytopenia in childhood. Pediatr Clin N Am. 2004;51:1109-40.

Beardsley DS. ITP in the 21st century. Hematology Am Soc Hematol Educ Prog. 2006:402-7.

George JN, Woolf SH, Raskob GE, Wasser JS, Aledort LM, Ballern PJ, et al. Idiopathic thrombocytopenic purpura: A practice guideline developed by explicit methods for the American Society of Hematology. Blood 1996;88:3-40.

Eden OB, Lilleyman JS. Guidelines for management of idiopathic thrombocytopenic purpura. The British Paediatric Haematology Group. Arch Dis Child. 1992;67:1056-8.

Imbach P, Barandun S, d’Apuzzo M, Baumgartner C, Hirt A, Morell A, et al. High-dose intravenous immune globulin for idiopathic thrombocytopenic purpura in childhood. Lancet. 1981;1(8232):1228-31.

Stasi R, Provan D. Management of immune thrombocytopnic purpura in adults. Mayo Clin Proc. 2004;79:504-22.

Tarantino MD, Bolton-Maggs PHB. Update on the management of immune thrombocytopenic purpura in children. Curr Opin Hematol. 2007;14:526-34.

Goodnough LT. Experiences with recombinant human factor VIIa in patients with thrombocytopenia. Semin Hematol. 2004;41:25-9.

Roganovic J. Rituximab treatment in refractory idiopathic thrombocytopenic purpura in children. Eur J Pediatr. 2005;164:334.

Cooper N, Evangelisat ML, Armadori S, Stasi R. Should rituximab be used before or after splenectomy in patients with immune thrombocytopenic purpura? Curr Opin Hematol. 2007;14:642-6.

Imbach P. Refractory idiopathic immune thrombocytopenic purpura in children. Current and future treatment options. Pediatr Drugs. 2003;5:795-801.

Sevier N, Houston M. Chronic refractory ITP in children: Beyond splenectomy. J Pediatr Oncol Nurs. 2005;22:145-51.

Sekhon SS, Roy V. Thrombocytopenia in adults: A practical approach to evaluation and management. South Med J 2006;99:491-8.

Kalpathi R, Bussel JB. Diagnosis, pathophysiology and management of children with refractory immune thrombocytopenic purpura. Curr Opin Pediatr. 2008;20:8-16.

Kojouri K, George JN. Recent advances in the treatment of refractory immune thrombocytopenic purpura. Int J Hematol. 2005;81:119-25.

Kuter DJ, Bussel JB, Lyons RM, Pullarkat V, Gernsheimer TB, Senecal FM, et al. Efficacy of romiplostim in patients with chronic immune thrombocytopenic purpura: a double-blind randomized controlled trial. Lancet. 2008;371:395-403.




How to Cite

Roganović, J. (2009). Idiopathic thrombocytopenic purpura in children. Acta Medica Academica, 38(1), 21–34. Retrieved from



Review Articles

Most read articles by the same author(s)

Similar Articles

You may also start an advanced similarity search for this article.