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Changing trends in the UK management of childhood ITP
  1. John D Grainger1,
  2. Joanne L Rees1,
  3. Marie Reeves1,
  4. Paula H B Bolton-Maggs2
  1. 1The University of Manchester, Manchester Academic Health Science Centre, Royal Manchester Children's Hospital, Manchester, UK
  2. 2Manchester Academic Health Science Centre, Manchester Royal Infirmary, The University of Manchester, Manchester, UK
  1. Correspondence to Dr John D Grainger, The University of Manchester, Manchester Academic Health Science Centre, Royal Manchester Children's Hospital, Manchester M13 9WL, UK; john.grainger{at}cmft.nhs.uk

Abstract

Objective To compare the treatment of childhood immune thrombocytopenia (ITP) with historical practice in the UK.

Design Data collection through a national UK Childhood ITP registry (http://www.uk-itp.org) started in January 2007.

Settings UK hospitals.

Participants Children admitted with a new diagnosis of acute ITP and their treating physicians.

Main outcome measures Bleeding severity, platelet count, disease management and outcome from the time of presentation to 6 months.

Results Data from 225 children were analysed. 54% of children had clinically mild, 42% had moderate and 4% had severe disease as defined previously.1 The mean platelet counts at diagnosis for these groups were 14, 8 and 6×109/l respectively. Children with mild disease had fewer bleeding sites (1.9), compared with moderate (2.5) or severe disease (3.6). There was one intracranial haemorrhage reported. At 6 months' follow-up, 32% had a persistent platelet count <150×109/l, but only 4.8% had a count <20. The proportion of UK children receiving platelet-raising treatment was noted to decrease from 61% in 1995 to 38% in 2000. The current UK 2009 registry data show a continued decrease in treatment to 16% of all the children. In contrast, historical international data report 69% of children receiving interventional therapy.

Conclusion The current UK practice has shown a continued reduction in the number of children receiving treatment in comparison with historical data and international practice.

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Footnotes

  • Funding The childhood ITP registry is supported by charitable donation for the ITP Support Association.

  • Competing interests JDG: honoraria for participation on advisory boards for GSK, Amgen and Baxter; research support from Baxter. PHB-M: participation in advisory board meetings for Amgen and GSK; chair of a satellite meeting for Baxter at BSH 2009; support for travel to international meetings by Baxter.

  • Patient consent Obtained.

  • Ethics approval Ethics approval was provided by the Northern NRES.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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