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Department of Pediatrics : Academic Divisions : Emergency Medicine : Resident Manual : Hematology & Oncology : ITP

Peak age 3-4 years

Prodromal viral symptoms in 2/3rd of cases

Mainly mucocutaneous bleeding: Petechiae, epistaxis, ICH very rare

RED FLAGS: presence of LAD, HSM and decrease in other cell lines

Initial investigations: CBC with diff and platelets, Peripheral smear, DAT, Rh type, serum Ig G,A,M levels, ANA, C3&4.

Treatment:

  • Symptomatic patients other than petechiae (regardless of platelet count)
  • Asymptomatic patients with platelet count < 20,000

Drugs: (premedication often necessary)

  • WinRho 75 microgram/kg IV (only for Rh+ patients with normal Hb) OR
  • IVIG 1g/kg IV infusion
  • Prednisone 4mg/kg/day for 4 days (NEED BMA prior to starting steroids)
  • Avoid NSAIDS (causes platelet dysfunction)
  • Platelets transfusions are used only in patients with intractable bleeding refractory to other treatments. (see transfusion guidelines)


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