Abstract Number: PB1239
Meeting: ISTH 2020 Congress
Background: Evidence-based guidelines for the management of immune thrombocytopenia (ITP) recommend an observation-based approach for the majority of pediatric patients with newly diagnosed ITP. A variability in adherence to this recommendations has been described. Moreover, there is still a lack of evidence regarding the utility of different management approaches, including general recommendations for sport participation.
Aims: To evaluate the current practice patterns of pediatric ITP treating physicians across Spain.
Methods: A questionnaire regarding management of a newly diagnosed pediatric ITP, studies at ITP onset, treatment, and general recommendations for daily life and sports participation in pediatric ITP patients was designed. A web-based survey tool, docs.google.com/forms was used to generate an online version of the questionnaire (table 1). Pediatricians, pediatric hematologists and hematologists treating pediatric ITP in Spain were invited to participate. Responses were collected and formatted using google forms.
Results: A total of 81 responses were collected from pediatric hematologists (66,7%), hematologists (23,5%) and pediatricians (9,9%). A 65,4% of respondents had treated pediatric ITP patients for more than 6 years, but only 37% of them treat more than 10 cases per year. Main responses are summarized in table 1. Figure 1a shows the variability in additional test requested in a newly diagnosed ITP. Figure 1b, the percentage of doctors that recommend the participation in sports of a chronic ITP teenager with a platelet count between 15-30.000/mmcc.
Conclusions: Despite of the existence of national and international guidelines, there is some variability in the diagnosis and management of pediatric ITP in our country. Those doctors treating less than 10 ITP per year tend to administrate treatment more frequently.
[1a: variability in additional test requested in ITP. 1: recommedations in sport participation]
| Clinical situation | Answers |
| Cases 1-3: Newly diagnosed ITP. Platelets 18.000/mmcc. Blood smears: normal. No hemorrhagic symptoms but skin lesions. | ·7-month-old toddler: 55.6% admission and observation and 23.5% home observation ·7-year-old child: 63% home observation; 19.8% admission and observation ·13-year-old teenager: 67.9% home observation and 22%* of admission and observation |
| Case 4: Newly diagnosed ITP. 5-year-old girl. 6.000/mmcc platelets. Normal blood smears. No hemorrhagic symptoms but skin lesions. | ·Admission and observation: 24.7% ·Treatment administration: GC: 29.6% IVIG: 37% |
| Bone marrow aspiration in newly diagnosed ITP | ·No one patient: 49.4% ·No response to GC and IVIG: 34.6% |
| Case 5: Newly diagnosed ITP. 3-year-old girl. Platelets 2.000/mmcc. Normal blood smears. Large hematoma secondary to traumatism. Positive direct coombs test. Would this change your attitude? | ·Similar treatment to other patients: 86.4% ·Long term GC: 8.6%* |
| Case 6: Persistent ITP. 7-year-old. Bone marrow aspiration compatible with ITP. Transient response to IVIG three times. No response to GC. Epistaxis during the last 48hours. 9.000/mmcc platelets. Attitude: | ·IVIG administration: 77.8% |
| Case 7: Similar to case 6 but there is no response to IVIG. Attitude: | ·TPO analogs: 72.8% ·IV GC bolus: 16%* |
| Case 8: Chronic ITP. 8-year-old girl. Transient response to IVIG (6 doses), all of them followed by mild headache as secondary effect. No response to GC. Epistaxis and bruises. She begs for participating in rhythmic gymnastics classes. Would you offer other treatment? | ·TPO analogs: 92.6% ·Others* |
| Cases 9 and 10: Minimum level of platelet count to allow a completely normal life in: | ·3-year-old child: 19.8% >20.000/mmcc; 34.6% >30.000/mmcc; 22.2% >50.000/mmcc ·10-year-old child: 23.5% > 20.000/mmcc; 30.9% >30.000/mmcc; 17.3% > 50.000/mmcc |
| Case 11: The patient insists on practicing a sport that you don’t recommend (bleeding risk). Would you start treatment to increase his platelet count? | Yes: 85.2% |
[Table 1: Summary of responses. *More relevant in those doctors treating less than 10 ITP every year.]
To cite this abstract in AMA style:
Berrueco R, Dapena JL, Monteagudo E, Astigarraga I, Cervera A, Dasí MA, Sastre A, Sebastian E. Variability in Diagnosis and Management of Immune Thrombocytopenia in Children: Real Life According to Spanish Pediatricians and Hematologists [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/variability-in-diagnosis-and-management-of-immune-thrombocytopenia-in-children-real-life-according-to-spanish-pediatricians-and-hematologists/. Accessed December 5, 2021.« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/variability-in-diagnosis-and-management-of-immune-thrombocytopenia-in-children-real-life-according-to-spanish-pediatricians-and-hematologists/