Idiopathic thrombocytopenic purpura in children.
ITP in childhood is most often of the acute, self-limited variety, with spontaneous recovery occurring within a matter of days or weeks. In many of these children, acute thrombopenic purpura follows in the wake of a viral infection. While the pathogenesis is not entirely clear, it seem probable that the platelet membrane is altered by virus or by soluble viral antigen-antibody complexes; platelets thus damaged become susceptible to rapid destruction by the RES. Management remains somewhat controversial. While almost all agree that corticosteroid should not be used in all cases of acute childhood purpura, there are still no clear-cut indications for their use, and no real evidence that they are of benefit in reducing the risk of the one rare but serious complication of childhood ITP, namely, intracranial hemorrhage (ICH). In approximately 5-10% of children, ITP ultimately proves to be of the chronic variety, and is in all probability the same condition that is seen in adults. Splenectomy is the treatment of choice, Another small subgroup of children have ITP of the recurrent acute variety; there is some evidence that this entity may also have an autoimmune pathogenesis. Infants born to mothers who have (or have had) ITP often manifest thrombopenia, with or without purpura and other bleeding. While this is generally a benign, self-limited process, requiring no treatment, ICH occurs in a small but significant number of affected infants and probably results from head trauma during delivery.