Recommendations

Vol. 22 No. 3 (2024): Blood Transfusion 3-2024 (May-June)

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

Authors

Key words: ITP, children, therapy, quality of life, management
Publication Date: 2023-07-27

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.

Downloads

Authors

Giovanna Russo - Pediatric Onco-hematology Unit, Azienda Policlinico Rodolico San Marco, Department of Clinical and Experimental Medicine, University of Catania, Italy https://orcid.org/0000-0001-9369-7473

Emilia Parodi - Pediatric and Neonatology Unit, Ordine Mauriziano Hospital, Turin, Italy https://orcid.org/0000-0002-4260-2689

Piero Farruggia - Pediatric Hematology and Oncology Unit, ARNAS Ospedale Civico, Palermo, Italy. https://orcid.org/0000-0002-3412-0399

Lucia Dora Notarangelo - Direzione Medica di Presidio, Children’s Hospital, ASST-Spedali Civili, Brescia, Italy https://orcid.org/0000-0001-5532-7375

Silverio Perrotta - Department of Women, Children and General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli”, Naples, Italy https://orcid.org/0000-0001-6149-6845

Maddalena Casale - Department of Women, Children and General and Specialized Surgery, Universita degli Studi della Campania "Luigi Vanvitelli”, Naples, Italy https://orcid.org/0000-0003-4740-2421

Simone Cesaro - Pediatric Hematology Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy https://orcid.org/0000-0002-8698-9547

Giovanni Del Borrello - Pediatric Oncohematology, Pediatrics Department, Hospital Città Della Salute e Della Scienza, Universit y of Turin, Turin, Italy

Giovanni Carlo Del Vecchio - Interdisciplinary Department of Medicine, Pediatric Section, University of Bari "Aldo Moro", Bari, Italy https://orcid.org/0000-0001-5462-0027

Fiorina Giona - Department of Translational and Precision Medicine, Sapienza University of Rome, AOU Policlinico Umberto I, Rome, Italy https://orcid.org/0000-0001-8054-6158

Chiara Gorio - Pediatric Onco-hematology Unit, Children’s Hospital, ASST-Spedali Civili, Brescia, Italy

Saverio Ladogana - Pediatric Onco-hematology Unit "Casa Sollievo della Sofferenza" Hospital, IRCCS, San Giovanni Rotondo, Italy

Giuseppe Lassandro - Interdisciplinary Department of Medicine, Pediatric Section, University of Bari "Aldo Moro", Bari, Italy

Antonio Marzollo - Pediatric Hematology, Oncology and Stem Cell Transplant Division, Padua University Hospital, Padua, Italy https://orcid.org/0000-0003-2177-8500

Karolina Maslak - Pediatric Onco-hematology Unit, Azienda Policlinico Rodolico San Marco, Department of Clinical and Experimental Medicine, University of Catania, Italy https://orcid.org/0000-0001-9112-7661

Maurizio Miano - Haematology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy https://orcid.org/0000-0002-9816-1704

Margherita Nardi - Pediatric Hematology Oncology, Bone Marrow Transplant, Azienda Ospedaliero Universitaria Pisana, S. Chiara Hospital, Pisa, Italy

Giuseppe Palumbo - Department of Pediatric Hematology and Oncology Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Department of Systems Medicine, University of Tor Vergata, Rome, Italy

Francesca Rossi - Department of Women, Children and General and Specialized Surgery, Universita degli Studi della Campania "Luigi Vanvitelli”, Naples, Italy https://orcid.org/0000-0003-2879-6277

Marco Spinelli - Pediatric Hematology Oncology Unit, Department of Pediatrics, IRCCS San Gerardo dei Tintori Foundation, Monza, Italy

Alessandra Tolva - Pediatric Hematology-Oncology, IRCCS Policlinico San Matteo, Pavia, Italy

Paola Saracco - Department of Public Health and Pediatric Sciences, Regina Margherita Children's Hospital, University of Turin, Turin, Italy

Ugo Ramenghi - Department of Public Health and Pediatric Sciences, Regina Margherita Children's Hospital, University of Turin, Turin, Italy https://orcid.org/0000-0003-3576-3510

Paola Giordano - Interdisciplinary Department of Medicine, Pediatric Section, University of Bari "Aldo Moro", Bari, Italy https://orcid.org/0000-0002-7762-3500

  • Abstract viewed - 2231 times
  • pdf downloaded - 984 times