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ITP in children
ITP in children is isolated thrombocytopenia in a well child after a viral infection; in most children it resolves on its own, so in a child with skin bleeding only the recommendation is observation — even when the platelet count is very low.
Why it matters in the exam
The typical description: a 3-year-old two weeks after a cold, with petechiae and bruises, looking well, with no enlarged liver, spleen or lymph nodes; on the blood count only the platelets are low, and the smear shows large platelets. The question is what to do: according to ASH 2019 — observation, not routine treatment. Treatment (a short course of steroids, IVIG, or anti-D) is kept for significant mucosal bleeding or dangerous bleeding.
The main trap is missing leukaemia: bone pain, prolonged fever, an enlarged liver and spleen, lymph nodes or a fall in other cell lines do not fit ITP and require a smear and a bone-marrow examination. Intracranial haemorrhage is very rare. ITP lasting 3–12 months is called persistent, and beyond 12 months — chronic; most children recover within a year, unlike adults.
Advice to the family includes avoiding contact sports and head injury while platelets are very low, using paracetamol instead of NSAIDs, and explaining the signs that require immediate attention: a nosebleed that does not stop, blood in the urine or stool, vomiting or a severe headache. In a baby with thrombocytopenia in the first days of life, think of other causes, such as maternal immune thrombocytopenia or infection.
Key points
- Isolated thrombocytopenia in a well child after a viral infection.
- Smear: large platelets; other lines normal.
- Skin bleeding only — observation (ASH 2019).
- Significant mucosal bleeding — short prednisone or IVIG 0.8–1 g/kg.
- Most children recover within 12 months; chronic beyond 12 months.
Summary table
| Issue | Typical ITP | What suggests another diagnosis |
|---|---|---|
| Clinical picture | Age 2–5, after a viral infection, petechiae and bruises, well child | Fever, bone pain, weight loss, enlarged liver, spleen or lymph nodes |
| Blood count and smear | Platelets below 100,000, other lines normal, large platelets | Anaemia, neutropenia, blasts on the smear |
| Treatment for skin bleeding only | Observation, whatever the count | — |
| Treatment for significant mucosal bleeding | Short prednisone (up to 7 days), IVIG 0.8–1 g/kg, or anti-D in an Rh-positive child | Anti-D is contraindicated when there is haemolysis |
| Course | Most children recover within 12 months | Chronic beyond 12 months — secondary work-up (autoimmune disease, immunodeficiency) |
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Sources
- American Society of Hematology guidelines for immune thrombocytopenia, 2019 — Management of newly diagnosed ITP in children
- Nelson Textbook of Pediatrics, 22nd edition (2024) — Immune Thrombocytopenic Purpura
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-02. The text may contain errors; when in doubt, check the source.