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. 2024 May;22(3):253-265.
doi: 10.2450/BloodTransfus.501. Epub 2024 Jan 29.

Recommendations for the management of acute immune thrombocytopenia in children. A Consensus Conference from the Italian Association of Pediatric Hematology and Oncology

Giovanna Russo  1 , Emilia Parodi  2 , Piero Farruggia  3 , Lucia D Notarangelo  4 , Silverio Perrotta  5 , Maddalena Casale  5 , Simone Cesaro  6 , Giovanni Del Borrello  7 , Giovanni C Del Vecchio  8 , Fiorina Giona  9 , Chiara Gorio  10 , Saverio Ladogana  11 , Giuseppe Lassandro  8 , Antonio Marzollo  12 , Karolina Maslak  1 , Maurizio Miano  13 , Margherita Nardi  14 , Giuseppe Palumbo  15 , Francesca Rossi  5 , Marco Spinelli  16 , Alessandra Tolva  17 , Paola Saracco  18 , Ugo Ramenghi  18 , Paola Giordano  8
Affiliations

Recommendations for the management of acute immune thrombocytopenia in children. A Consensus Conference from the Italian Association of Pediatric Hematology and Oncology

Giovanna Russo et al. Blood Transfus. 2024 May.

Abstract

Background: Immune thrombocytopenia (ITP) is an acquired immune-mediated bleeding disorder characterized by isolated thrombocytopenia. Its estimated yearly incidence in the pediatric population is 1.9-6.4/100,000. ITP in children is usually a self-limiting and benign disorder. The clinical management of children with ITP often remains controversial, as robust randomized trials on the management of this disorder are lacking. Treatments vary widely in clinical practice and existing guidelines from hematology societies on clinical management offer indications based largely on expert opinion rather than strong evidence.

Materials and methods: The Coagulative Disorder Working Group of the Italian Association of Pediatric Hematology and Oncology (AIEOP) developed this document to collect shared expert opinions on the management of newly diagnosed ITP, updating previous guidelines and providing recommendations to pediatricians. Each statement has been given a score expressing the strength of evidence, appropriateness and agreement among participants.

Results: Clear-cut definitions of the clinical phases of the disease and clinical response are stated. Recommendations are given regarding the classification of bleeding symptoms, evaluation of bleeding risk, diagnosis, and prognostic factors. Specific recommendations for treatment include indications for first-line (intravenous immunoglobulins, steroids) and second-line (combined therapy, thrombopoietin receptor agonists, immunosuppressive drugs, rituximab) therapeutic agents, as well as hemorrhagic emergency and supportive treatment, including emergency splenectomy. The optimal follow-up schedule, the relation between ITP and vaccines and health-related quality-of-life issues are also discussed.

Discussion: The panel achieved broad consensus on issues related to how to treat children with newly diagnosed ITP, providing a comprehensive review of all relevant clinical aspects.

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Conflict of interest statement

CONFLICTS OF INTEREST: All participants were asked to fill out a disclosure form, stating actual and potential conflicts of interest. SP and GR have received honoraria from Novartis as invited speakers; CS has received honoraria from Amgen and Novartis as an invited speaker and has received a contribution from Novartis for medical writing; UR received a contribution from Novartis as support for a Meeting. All the other Authors have no potential conflicts of interest.

Figures

Figure 1
Figure 1
Flow chart summarizing the treatment options ITP: immune thrombocytopenia; IVIg: intravenous immunoglobulin; TPO: thrombopoietin; MMF: mycophenolate mofetil.
See this image and copyright information in PMC

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