Musa Kalim, Liaqat Ali, Asmat Ara Khattak.
Childhood idiopathic thrombocytopenia: clinical profile and management.
J Postgrad Med Inst Jan ;19(1):101-5.

Objective: To find out frequency of various clinical findings in children with idiopathic thrombocytopenic purpura and to evaluate the response of different management options. Material and Methods: This study was conducted at Paediatric Department, LRH, Peshawar from 1st October 2003 to 30th September 2004 (One year). A total of 20 patients of ITP were encountered during this period and were evaluated. Our panel decided to use the American Society of Haematology definition for ITP, which reads ITP as "Isolated thrombocytopenia with no clinically apparent associated condition or other causes of thrombocytopenia". After taking detailed history and thorough examination, relevant investigations like peripheral smear, bleeding time, clotting time and coagulation screen were carried out in all cases. Bone marrow examination was done only in selected cases. Patients were given chance of spontaneous recovery except in cases with platelet count <20,000 and with heavy bleeding from any orifice. Such cases were treated with platelet transfusion and steroids. Results: The study included 20 patients of whom 12 were males and 8 were females in the age range of 18 months to 14 years (mean age = 5.2 years). The commonest clinical symptoms and signs were bruises, epistaxis and gum bleeding. The commonest laboratory findings were Thrombocytopenia and prolonged Bleeding Time (in all cases). Bone marrow examination was done in three cases and was consistent with the diagnosis of ITP. Fifteen patients were offered chance for spontaneous recovery. Five patients received platelet transfusions and steroids. These were the cases who bled heavily and platelet counts less than 20,000. None of our patients had chronic ITP on their reviews so splenectomy was not performed in any of 20 cases. Conclusion: The results of our study highlight the importance of wait and see policy and not to do bone marrow aspiration in every child with typical presentation of ITP as 90% of cases resolve spontaneously. Special smear to be done in all cases and treat the child rather than number of platelets.

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