Your child has been diagnosed with the condition immune thrombocytopenia (ITP).
In ITP, the small cells needed for normal blood clotting (called platelets) are too low. When platelets are low, the body has trouble healing wounds and cuts.
You will meet with your child's health-care team to decide what treatment option is best. This article outlines the information you need to help you and your child's doctor make an informed decision together.
Signs of ITP
Your child may bruise easily or develop tiny red spots on the skin (called petechiae). Less often, children may bleed from the nose or gums or have blood in their stool.
Most bleeding is mild and only involves the skin (bruising or petechiae). Mild bleeding at the skin does not put your child at serious risk.
The most serious type of bleeding is in the brain. This is extremely rare: between one and four out of every 1,000 children diagnosed with ITP develop bleeding in the brain.
Apart from these physical signs of ITP, your child looks well and acts normally.
What causes ITP?
Usually, a child develops ITP after a viral infection such as a cold. The virus triggers a normal immune response, meaning the immune system starts destroying the virus. But the immune system also starts destroying healthy platelets. It is not clear why this happens.
Treatment for ITP
There are three options to consider. Each option is a reasonable choice and has its own advantages and disadvantages. Your child's health-care team will discuss these options to help you decide which is best.
All children with ITP will need to be monitored and all children whose platelet counts are low are at risk for bleeding from falls and injuries. As long as your child's bleeding is limited to the skin (for example bruising, petechiae or mild bleeding that stops on its own), there is no rush to make a decision.
Different families have different preferences when it comes to making medical decisions. We want to include your values in the decision-making process. A team of haematologists (blood specialists), and sometimes paediatricians, will meet you to discuss your child's case and the available options and answer any questions. Together, it is possible to make a decision that best suits your child and your family.
Option 1: Observation
During observation, your child is not given any medications. Instead, the doctors will book follow-up appointments to closely monitor your child.
Observation is an acceptable choice for managing ITP when bleeding only happens on the skin (for example bruising, petechiae or mild bleeding that stops on its own).
If your child has persistent bleeding from the nose or gums, they will likely need to start a different treatment option (prednisone or IVIG).
What are the advantages of observation?
Observation avoids the risks and side effects of medications. Your child will not need to stay in the hospital.
What are the disadvantages of observation?
During observation, the number of platelets remains low for longer. As long as the platelet count is low, your child's doctors will recommend avoiding activities that can cause serious falls and injuries.
If your child is especially prone to injuries, observation may not be a good option.
Option 2: Treat with prednisone
Prednisone is a steroid medicine. It is not the same steroid as the one taken by some athletes. Instead, prednisone is like a steroid that occurs naturally inside the human body.
Doctors have been using prednisone for decades to treat different conditions. For ITP, prednisone helps the immune system stop destroying platelets.
Your child takes two to three doses of prednisone by mouth each day for four days.
What are the advantages of prednisone?
Your child does not need an IV and can take prednisone at home.
Platelets can start to increase as early as 24 to 48 hours after starting prednisone, but it may take as long as one week.
What are the disadvantages of prednisone?
Some children do not like the taste of liquid prednisone. You can try mixing it with food to make it easier for your child.
Some children may experience side effects, which include:
- mood swings
- increased appetite
These side effects usually happen when prednisone is taken for a long time (longer than a week). Your child will probably not experience any of these side effects during the short time (four days) they are taking prednisone.
Option 3: Treat with intravenous immunoglobulin (IVIG)
Your child is treated with a blood product called immunoglobulin (IVIG).
In ITP, the immune system releases antibodies that destroy the platelets. Immunoglobulin blocks these antibodies and protects the platelets. It is part of our immune system and is extracted from donated blood.
While your child is in the hospital, IVIG is given intravenously (into the vein) over a few hours.
If your child has bleeding only on the skin (e.g., bruising, petechiae) or mild bleeding that stops on its own, then IVIG is discouraged in most cases. This is because observation and prednisone are safe options with fewer side effects, that do not require hospitalization.
What are the advantages of IVIG?
Platelets usually start to increase as early as 12 to 24 hours after receiving IVIG, but it may take as long as three days.
What are the disadvantages of IVIG?
IVIG requires an intravenous tube (IV) and must be given in a hospital.
Some children may develop side effects, which include:
- headaches (some children can get bad headaches the next day)
- nausea
- vomiting
- rash, fever, and chills (rarely).
Antihistamines or acetaminophen can be used to treat most of these symptoms. These side effects all go away eventually.
IVIG is safe and always cleaned. Since it is a blood product, its risks are similar to other blood transfusions. Talk to your child's doctor if you have any questions or concerns.
Important things to know about living with ITP
ITP usually goes away on its own after a few months. The immune system eventually settles down and stops attacking your child's platelets. Until then, your child's activities need to be limited to help reduce the risk of bleeding.
- If your child is a toddler, keep a close eye on them to minimize the risk of falls and tumbles.
- Ensure your child wears helmets while on bicycles or scooters and while skating or skiing. Now is a great time to reinforce this rule!
- Have your child avoid contact sports and rough play. The lower your child's platelet count, the more you will need to limit their physical activity. Your child's doctor will talk more about this with you.
- Tell your dentist about your child's ITP before each appointment. Remind your primary care provider about your child's ITP and treatment before receiving immunizations or new prescription medication. Avoid acetylsalicylic acid (ASA) or other anti-inflammatory medications (e.g., ibuprofen).
At SickKids
Before your child leaves the Emergency Department or hospital, your health-care tean will arrange a follow-up blood test (platelet count) and appointment with the Haematology Clinic (either at SickKids or closer to home) within one week.
You will also get contact information for a Haematology Clinic nurse. You can contact the nurse with any questions or concerns (Monday to Friday from 9 a.m. to 5 p.m.).
You will also get a contact number to call the Haematology fellow on call in case of emergencies in the evenings or on weekends.