Our aim is to identify, analyze and compare the international guidelines or national consensus reports on the management of immune thrombocytopenia in children.(ITP).
We performed a systematic search on PubMed database using keywords:‘imune thrombocytopenia in children AND [‘children’ OR ‘pediatric’ OR ‘paediatric’] AND [‘guideline’ OR ‘consensus’] between 1992 (first guideline) and 2020. We excluded publications written in other languages than English or French and animal studies. A total of 54 papers have been initially found. After exclusion of those that were not relevant or other types of publications than guidelines or consensuses (reviews, case series, case reports) we ended up in gathering 44 publications. After full text screening, we excluded papers that did not particularly refer to ITP guidelines but to quality of life, adherence to treatment etc. Finally 6 papers have been found to meet such strict criteria.
They are only six countries in the world published having a specific ITP published in Pub Med:USA with American Society of Oncology Guidelines for Immune Thrombocytopenia, Great Britain, Spain, Italy, Argentine and Japan.
The USA and Italian Guidelines recommend for children newly diagnosed with ITP without bleeding or minor bleeding observation rather than corticosteroids and Immunoglobuline IV (USA). For Children with non-life threating mucosal bleeding the american guideline suggest cortycotherapy no longer than 7 days. For the forms non-responsive at the first line the treatament, the American and Spanish Guidelines indicate thrombepoetin receptors agonist( TPO-RA-Eltrompobag) rather than Rituximab and Splenectomy. According to the spanish guideline cortycotherapy is the first choice therapeutic. Generally the primary goals of these guidelines are to review and implement evident based-recommandations. Other treatments include Azathiopirine, Cyclophosphamide, Cyclosporine A, Dapsone, Danazol and Myofenolate of Mofetil. In 2018 a joint working group (JWG) of several hematology societies (Germany, Switzerland, Austria) published a European Guideline for adults with ITP but more limitate for children with ITP ( no standard trateament for chronic ITP at children).
The splenectomy is universally the last options for treatament in ITP at children.
The general purpose of the Guidelines are the implement new therapies (Eltrompobag/Romiplostim) at children because they are rather than cortycotherapy and immunoglobuline iv (which are important side-effects and expansive bugets ). At children for Eltrompobag are raported minor or moderate side-effects and no for long therm.
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