Children who have ITP disease may eventually be considered candidates for splenectomy. This surgical procedure is usually used when medical management of the disease has failed for 12 months. There are several reasons why a child might be considered a candidate for this procedure. For example, ITP disease in children can have an impact on a child’s emotional and mental health.
Splenectomy is considered after failure of medical management in a child with ITP for at least 12 months
Splenectomy is a surgical procedure for chronic ITP that is effective in improving platelet count and reducing associated bleeding. This surgery is recommended by the American Society of Hematology for children at least 12 months after diagnosis. It should not be performed on children under the age of five years. It is most effective in patients with persistent low platelet counts, significant bleeding, or inadequate response to standard medications.
Splenectomy is not always successful, and it should be considered only after a child has failed medical management for at least 12 months. In the past, splenectomy was considered second-line treatment, but this practice has declined substantially in recent years. Experts now advocate the use of receptor agonists, such as rituximab, romiplostim, and eltrombopag, in patients with ITP. However, there have been no studies comparing the effectiveness of receptor agonists and splenectomy. Nevertheless, most guidelines still recommend splenectomy in children with ITP after 12 months.
Pediatric ITP is a heterogeneous disorder. The type of thrombocytopenia, the duration of disease, and the response to treatment differ greatly among patients. Therefore, the treatment of pediatric ITP is complex, especially in patients with chronic ITP, multi-lineage cytopenia, or thrombopenia associated with an underlying systemic disorder. Pediatric researchers are increasingly identifying genetic risk factors and developing better targeted therapies to improve the quality of life for children with ITP.
A platelet count of less than 100×109/L is diagnostically significant for ITP. However, a platelet count between 100 and 150×109/L is often in the normal range.
Exclusion criteria for ITP disease
A patient with ITP is excluded from a study if two other family members also have the disease. Although there is no single, sensitive test for ITP disease, a physician should suspect it and rule out other potential causes of thrombocytopenia before concluding the diagnosis. The workup includes history, physical examination, peripheral smear, and complete blood cell count with leukocyte differential. Clinical history should include any stigmata from other systemic diseases. HIV testing should also be performed if the patient is in a high risk group.
This study included 287 patients with ITP. Of these, 217 fulfilled the inclusion criteria. The median age was 3.5 years, and the most common reasons for hospitalization were thrombocytopenia, bleeding signs, petechiae, and hematomas. Ninety-six percent of patients had bleeding scores of 3 or higher, which corresponds to low bleeding risk. Thirty-three patients required blood products, which included IVIG and GC.
Patients in this study must be 18 years of age or older and have primary, persistent ITP. Their platelet count should be below 50000/mL. They must also have no bleeding within one month of the study start date. Furthermore, individuals who had a splenectomy within three months of the study’s initiation period will be excluded.
In addition to these requirements, patients with ITP should also be free from other known causes of thrombocytopenia and a good response to immunosuppressive therapy. These criteria are also based on the treating physician’s experience. The researchers are hopeful this study will reveal more information about the clinical characteristics of ITP and its associated risk.
Children with severe immune thrombocytopenia often exhibit minimal symptoms and improve within three to six months. On the other hand, patients with more severe cases may need to be treated for six to twelve months. However, it is difficult to predict the course of the disease in both patient populations. While the American Society of Hematology recommends against the use of pharmacological interventions, they are sometimes necessary if bleeding symptoms are severe.
Treatment options for ITP disease
There are many different treatment options for ITP disease, and most of them involve raising platelet counts. However, the treatment for this condition can be complex and often requires multiple types of medication. Some treatments can be very costly and require weekly visits to the doctor. Other types of treatment include lifestyle modifications. To decide which treatment is best for you, talk to your doctor about your specific needs and the side effects of any medications.
Corticosteroids are a common first-line treatment for ITP. These drugs can be taken orally or given intravenously. Common corticosteroids are oral prednisone and high-dose dexamethasone. Corticosteroids block the immune system, which in turn reduces harmful proteins.
A laboratory test for ITP disease can be done on patients with symptoms of the condition. Antiplatelet antibodies, which are produced by the immune system to attack foreign microorganisms, can be detected in up to 50% of patients with the disease. However, this test has not been shown to be a reliable diagnostic tool. In some cases, the presence of these antibodies may indicate a different cause of thrombocytopenia, and it does not correlate with the outcome of the disease.
Current recommendations for the treatment of ITP disease include the use of corticosteroids and thrombopoietin receptor agonists. Various studies have demonstrated that these drugs may be effective alone or in combination with other treatments for the disease. Nevertheless, it is important to note that these treatments may not work for all patients.
Another treatment option for ITP disease involves the use of an antibody called rituximab, which inhibits the production of anti-platelet antibodies. Although this medication does not increase the risk of infection, it may cause side effects like fever, chills, or headaches. A patient with chronic ITP may also be prescribed IVIG infusions, which contain monoclonal antibodies to control the immune system.
Impact of ITP disease on mental and emotional health
Children and adolescents with ITP disease may be able to benefit from a better understanding of the emotional and mental implications of the disease. The disease limits physical activity and limits the child’s social and emotional life. Although the majority of children with ITP have mild symptoms, there are some who experience fatigue, mental health difficulties, and difficulty coping with behavioural and emotional symptoms. As these symptoms can interfere with daily activities, they can lead to feelings of frustration and isolation.
In addition to behavioural and emotional symptoms, ITP has been associated with a number of cognitive impairments. Researchers have studied the association between ITP and impairments in executive function and fatigue. A recent review of childhood ITP has called for research on the cognitive profile of children and adolescents with the disease.
The etiology of ITP remains poorly understood. Nevertheless, it has been demonstrated that patients with low platelet counts are at greater risk of developing complications than patients with normal platelet counts. In addition, the patient’s platelet count can affect the choice of treatment. Many patients report that close monitoring of platelet counts is as stressful as the disease itself. Some patients with ITP underwent a splenectomy in the hope of achieving full remission. This surgery may lead to anxiety and confusion about the ability to have children.
The study team involved a project member who transcribed the focus group transcripts into individual text units. These units ranged in length from phrases to entire paragraphs. Each text unit was a representation of the impact of ITP on the patient’s life. The results of the study will be presented in a later publication.
Impact of ITP disease on work and financial situation
Many patients have concerns about the quality of their life and the impact of ITP on their work and financial situation. One study found that nearly 40% of patients with ITP said that their condition affected their emotional well-being, and that they had missed work because of the disease. Two-thirds of patients reported that fatigue was their primary symptom at diagnosis and at the time of the survey.
In resource-limited settings, the burden of ITP is even greater. Physicians in these settings are often limited in their time in the clinic, and assessing HRQoL parameters is difficult. As a result, many physicians underreport these factors in routine clinical practice. In addition, prevention of bleeding is the primary goal of treatment for ITP.
Patients with ITP often worry about the impact their disease will have on their ability to work or participate in social activities. However, studies have shown that the impact of the disease tends to diminish over time as patients learn coping strategies and respond to treatment. There is no cure for ITP, but treatments are available that can raise platelet counts and control symptoms.
Physicians and patients must educate themselves about the impact of ITP on their patients. In addition, they must educate physicians on the fact that the disease can cause bleeding in a wide range of ways. For example, doctors must focus on symptoms that patients rarely report and on the support systems that are essential to patients.
While rare, recurrence of ITP is possible, even several years after the first episode. In some cases, this recurrence of ITP is associated with another viral infection.