| disease | Idiopathic Thrombocytopenic Purpura in Children |
Idiopathic thrombocytopenic purpura (ITP) is a common bleeding disorder in children. After more than 40 years of research, it has been proven that this disease is related to the body's immune system and is considered an autoimmune disease. Clinically, it is characterized by spontaneous bleeding in the skin and mucous membranes, often preceded by a history of viral infections such as upper respiratory tract infections (common cold). This disease is divided into acute and chronic types. Acute idiopathic thrombocytopenic purpura is more common in children, affecting all age groups but predominantly infants and young children, with a higher incidence in spring. Approximately 80–90% of pediatric acute cases recover within 6 months, while 10–25% progress to chronic ITP. Chronic cases are more common in school-aged children, with a disease course lasting over 6 months, and about one-third to one-half recover within 5 years. In rare acute cases, severe bleeding (especially intracranial hemorrhage) may occur, leading to death.
bubble_chart Clinical Manifestations
1. A history of viral infection, such as upper respiratory tract infection, measles, or chickenpox, within 1-6 weeks before the onset of illness. 2. Sudden onset with severe bleeding, primarily spontaneous bleeding of the skin and mucous membranes, commonly seen in the skin, oral mucosa, gums, and conjunctiva, as well as the nasal cavity and trauma sites. Gastrointestinal and urinary tract bleeding are rare, and intracranial bleeding occasionally occurs. 3. Pinpoint hemorrhagic spots or petechiae on the skin, with a few cases presenting grade I hepatosplenomegaly.
1. Repeated laboratory tests show a decrease in platelet count. 2. The spleen is not enlarged or is only grade I enlarged. 3. Bone marrow examination reveals an increased or normal number of megakaryocytes with maturation disorders. 4. At least two of the following five criteria must be met: (1) Effective response to prednisone treatment. (2) Effective response to splenectomy. (3) Increased PAIG. (4) Increased PAC3. (5) Shortened platelet lifespan measurement. 5. Secondary thrombocytopenia must be ruled out.bubble_chart Treatment Measures
Treatment of
1. Bed rest to avoid trauma. 2. Prevent and control infection. 3. Actively control bleeding. 4. Surgical treatment if necessary.
1. Cure: No bleeding symptoms, platelet count >100×109/L, lasting for more than 3 months. No recurrence. 2. Improvement: Bleeding disappears or improves, platelet count rises to 20–50×109/L but does not reach 100×109/L, confirmed by three consecutive tests or observed for more than 2 weeks. 3. No cure: Bleeding symptoms do not improve or worsen, and the platelet count fails to meet the improvement criteria.
[Expert Tips]
If a child experiences nosebleeds, gum bleeding, or skin bleeding, they should be taken to the hospital for examination immediately. Once thrombocytopenia is detected, it is best to hospitalize the child for further tests and systematic treatment. Outpatients must strictly follow the doctor's instructions to avoid severe bleeding that could endanger the child's life. The following points must be noted: (1) Limit physical activity; bed rest is recommended to avoid trauma. (2) Eat easily digestible foods; avoid dry, hard, or spiky foods to prevent injury to the mucous membrane and subsequent bleeding. (3) Avoid medications such as aspirin and dipyridamole. (4) Take precautions against viral infections (e.g., common cold) to prevent worsening of the condition.
