Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ Key Features +++ Essentials of Diagnosis ++ Otherwise healthy child Decreased platelet count Petechiae, ecchymoses +++ General Considerations ++ Most common bleeding disorder of childhood Occurs most frequently in children aged 2–5 years Often follows infection with viruses, such as Rubella Varicella Measles Parvovirus Influenza Epstein-Barr virus (EBV) Acute and chronic HIV Most patients recover spontaneously within a few months Chronic ITP (> 12 months' duration) occurs in 10–20% of affected patients +++ Clinical Findings ++ Sudden onset, with appearance of multiple petechiae and ecchymoses Epistaxis is common at presentation Rarely, concurrent infection with EBV or CMV may cause hepatosplenomegaly or lymphadenopathy, simulating acute leukemia +++ Diagnosis ++ Platelet count is markedly reduced (usually < 50,000/μL and often < 10,000/μL) Platelets are frequently large on peripheral blood smear, suggesting accelerated production of new platelets Platelet-associated IgG or IgM, or both, may be demonstrated on the patient's platelets or in the serum Prothrombin time and activated partial thromboplastin time are normal White blood count and differential are normal Hemoglobin concentration is preserved unless hemorrhage has been significant Number of megakaryocytes is increased Erythroid and myeloid cellularity is normal +++ Treatment +++ General Measures ++ Observation is recommended for most children in the absence of bleeding regardless of platelet count Food and medications (eg, aspirin and nonsteroidal anti-inflammatory drugs) that compromise platelet function should be avoided Bleeding precautions (eg, restriction from physical contact activities and use of helmets) should be observed +++ Medications ++ Corticosteroids Short course may benefit patients with clinically significant but non–life-threatening bleeding and those with a platelet count of less than 10,000/μL Dosing Initial dose of prednisone 3–5 mg/kg/d for 3–7 days may lead to faster count recovery Additional prednisone not given unless significant bleeding recurs, at which time smallest dose that achieves resolution of bleeding episode is administered (usually 2.5–5 mg twice daily) Long-term use should be avoided because of toxicity Intravenous immunoglobulin (IVIg) Treatment of choice for severe, acute bleeding May be used as an alternative or adjunct to corticosteroid treatment A single dose of 0.8–1 g/kg has been recommended Platelets may be given simultaneously during life-threatening hemorrhage but are rapidly destroyed Anti-Rh(D) immunoglobulin Effective only in Rh(+) patients with a functional spleen who are DAT negative At doses of 50–75 μg/kg, approximately 80% of Rh(+) children with acute or chronic ITP respond However, there is no clear difference between anti-D and IVIg in the time to reach the end point of achieving a platelet count of 20 × 109/L +++ Surgery ++ Splenectomy Produces a complete response in 70% and partial response in 20% of children Should be considered only after persistence of significant thrombocytopenia for more than 12 months, and the failure ... Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth