Pediatric Immune Thrombocytopenic Purpura (ITP)

When we perform a simple blood test we can distinguish three main types of cells: red blood cells or red cells, white blood cells or leukocytes and platelets. When a patient is informed that he is anemic, we understand that the number, quantity, or color and size of red blood cells are below the limits that are considered normal. When a patient is told, less commonly, that he has leukopenia, specialists mean that the leukocytes or white blood cells are also below what is considered normal. Finally, which is what will be discussed in this article, when platelets are low we say that the patient suffers from thrombocytopenia or thrombopenia, which can be perceived as a purpura (reddish spots), purpuric hemorrhagic (purple color) thrombocytopenic or with nosebleeds, or the commonly called cardinals.

Characteristics of thrombocytopenia

Having given these simple concepts, it should be made clear that immune thrombopenia in the pediatric age group is relatively frequent, sometimes dramatic, usually of short course and of absolute cure in up to 90% of cases. No more than 10 – 20% become chronic, i.e., they exceed the time thus considered of 12 months and, in general, this chronicity is more common in older children, young people and adults.

The term “immune” refers to something not easy to understand by the patient himself, it means that in some way, the organism reacts in an abnormal way, that is to say, it defends itself against something that is happening in the platelets of its own organism; it fights in some way against itself destroying them and giving rise to showy manifestations.

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When a child, meaning a child under the age of 15-18 years, has a platelet count below the limit (currently recognized as normal 100,000 platelets per mm3), we speak of immune thrombocytopenic purpura.

Immune thrombocytopenic purpura

In general, this disease will present itself in 80% of the cases in an acute form, and it is not at all unusual in children for this figure to be below 10,000 or even 20,000 mm3. The term “immune” refers to something not easy to understand by the patient himself, it means that in some way, the organism reacts in an abnormal way, that is to say, it defends itself against something that is happening in the platelets of its own organism; it fights in some way against itself destroying them and giving rise to showy manifestations.

When a child, meaning a child under the age of 15-18 years, has a platelet count below the limit (currently recognized as normal 100,000 platelets per mm3), we speak of immune thrombocytopenic purpura.

Immune thrombocytopenic purpura

In general, this disease will present itself in 80% of the cases in an acute form, and it is not at all unusual in children for this figure to be below 10,000 or even 20,000 mm3. The child or young adolescent will go to the pediatrician because the family reports that they have noticed manifestations of a hemorrhagic appearance on the skin or mucous membranes, such as: blood in the skin, nose (epistaxis), blood on occasion in the digestive tract or detection or observation of the appearance of urine that is slightly redder or more concentrated. These last three findings are extremely rare. The usual thing is to go to the pediatrician for the appearance of bruises (bruises, usual terminology in medicine) more or less large, generalized and bleeding from the nose or gums.

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In the absence of any other symptomatology and reviewing a history of two to three weeks, where viral or non-flu type febrile processes are detected, an intake of some type of medication, with the potential possibility of toxicity to the cells of our body; and in the absence of unexplained fever or other alterations, the minimum obligation at that time is to perform a simple blood test where the numbers of red blood cells, white blood cells, platelets and the morphological aspect of these cells, i.e. the appearance and normal count or the three types of cells highlighted in the first paragraph, will be assessed.

Thrombocytopenia

In the case of thrombocytopenia, the only thing that will be altered will be the low number of platelets, which will confirm the diagnostic suspicion of this entity and will allow us to rule out more or less serious diseases that would imply an absolutely different explanation, behavior and prognosis.

The only serious and serious, truly worrying problem of thrombocytopenia at this age is the potential risk of a hemorrhagic manifestation at the level of the vitals structures of our organism. In this case, present in the brain and will always be referred to as a worse prognostic factor, but we can also assess that its incidence does not exceed 0.1 – 0.2% of thrombocytopenias and, even in the case of its manifestation, urgent early action of supportive measures could avoid undesirable sequelae.

More than 80% of cases of this disease are acute, that is to say, they appear abruptly in two, three or four days and disappear; it also resolves acutely in less than seven days and 6 – 12 months, but already within platelet rates that are compatible with the usual vital activity of the child, exceeding 50,000 mm3, and with the understanding that the risks of complications are practically nil.

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Treatment of thrombocytopenia

The clinical action and from the point of view of the treatment of this disease in the child is clear, concrete and protocolized. Depending on the platelet counts, the symptoms presented by the child, dry manifestations, bruising (bruises), red spots, petechiae, etc. and more than 10,000 platelets mm3, the attitude is often “wait and see”, i.e., wait and see. Most cases resolve without any therapeutic approach. If the manifestations are wet, epistaxis, bleeding gums, intestinal urinary tract, among others, and the number of platelets is below 20,000 mm3, the attitude will be the administration of ganmaglobulins, ie, defenses against the problem that is occurring, or corticosteroids, drugs that fortunately serve for many treatments in medical practice.

If the disease and its manifestations are severe and life-threatening, any therapy, any treatment is useful, from shortosteriods, ganmaglobulins, platelet transfusion to the performance of a splenectomy, i.e. removal of the spleen, the place where normal platelets are usually destroyed.
Oral treatments with platelet-forming colony-stimulating drugs have recently been marketed, which in many cases solve the problem of patients with chronic or refractory disease, i.e., those who do not respond to anything and must be periodically monitored in hospitals, and which fortunately are becoming less and less frequent.