Controversies in the treatment of pediatric immune thrombocytopenias

Blood Reviews
D J Nugent

Abstract

Although pediatric immune thrombocytopenia (ITP) is common, there is no consensus on the optimal approach to therapy. Childhood ITP differs in its clinical course and trigger from adult immune thrombocytopenic purpura. There appear to be two clinical phenotypes among children with ITP: children with polyclonal autoantibody production triggered by an external exposure such as infection, and children with coexistent immune deficiency or dysregulation on a congenital or acquired basis. Treatment implications exist for each group. The first may be best managed by observation and conservative measures; for the latter, treatment could include normal intravenous gammaglobulin concentrate, anti-blood group D antigen (anti-Rh factor), or steroids. Early recognition of the thrombocytopenic child with immune dysfunction versus the normal child with a polyclonal response to a particular environmental antigen will result in better prognosis for both by selecting the appropriate therapy and minimizing long-term side effects.

Citations

Dec 2, 2004·Expert Opinion on Pharmacotherapy·S Gerald Sandler, S Osman Tutuncuoglu
Jan 24, 2009·Pediatric Blood & Cancer·George B Segel, Stephen A Feig
Sep 26, 2009·Clinical Chemistry and Laboratory Medicine : CCLM·Pierrot L TugirimanaJoris R Delanghe
Mar 5, 2013·Nutrition in Clinical Practice : Official Publication of the American Society for Parenteral and Enteral Nutrition·Pierrot TugirimanaJoris R Delanghe
Oct 6, 2006·Current Opinion in Anaesthesiology·Carl-Erik Dempfle
Aug 8, 2008·Blood Coagulation & Fibrinolysis : an International Journal in Haemostasis and Thrombosis·Bing BaiJogin R Wu
Apr 29, 2010·Current Rheumatology Reports·Nichola Cooper, James B Bussel

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