Newly Diagnosed Immune Thrombozytopenia – German Guideline Concerning Initial Diagnosis and Therapy

 

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Abstract

Newly diagnosed immune thrombocytopenia occurs in 3–5/100 000 children < 14 y per year. Bleeding symptoms do not correlate with platelet count. Diagnostic approach includes history, clinical examination and analysis of blood count with blood smear by experienced hematologist. Additional investigations are only necessary in atypical cases and cases with additional symptoms or inadequate response to therapy. The decision to treat ITP should be made cautiously and not entirely be based on the platelet count. Decisions based on clinical symptoms and progress of the illness are more reasonable. There is no evidence, that therapy at the time of diagnosis influences the further course and can avoid intracerebral hemorrhage.

Zusammenfassung

Die neu diagnostizierte ITP betrifft 3–5/100 000 Kinder pro Jahr. Die klinische Symptomatik korreliert nicht mit der Plättchenzahl. Die Diagnose ist vom erfahrenen Pädiater oder Hämatologen durch Anamnese, klinische Untersuchung sowie Erstellung eines Blutbildes mit mikroskopischer Differenzierung des Ausstrichs zu stellen. Zusätzliche Untersuchungen sind nur bei atypischen Verläufen, zusätzlichen Symptomen oder unzureichendem Therapieansprechen erforderlich. Die Indikation zur Behandlung einer ITP ist zurückhaltend zu stellen und gründet sich nicht allein auf die Thrombozytenzahl. Ein Vorgehen auf der Grundlage der Klinik setzt sich immer mehr durch. Es gibt keine Evidenz, dass eine Therapie bei Diagnosestellung den weiteren Verlauf beeinflussen und eine zerebrale Blutung verhindern kann. Es gibt keine Evidenz, dass eine Therapie einem nicht blutenden Patienten einen Vorteil bringt.

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