Idiopathic thrombocytopenic purpura: current issues for pathogenesis, diagnosis, and management in children and adults.

Current issues for idiopathic thrombocytopenic purpura (ITP) in children and adults are reviewed. Appropriate initial management of ITP in children is controversial. Some physicians favor specific treatment, whereas other physicians advocate only supportive care until the expected spontaneous remission occurs. In adults, ITP is typically persistent. Treatment is appropriate only for severe and symptomatic thrombocytopenia because prevention of bleeding is the only goal. If patients do not respond to initial glucocorticoid treatment, splenectomy is the appropriate second modality, resulting in sustained remissions in more than 66% of patients. For patients who have severe and symptomatic thrombocytopenia after splenectomy, treatment options are unclear. Intensive immunosuppression may be effective, but stimulation of platelet production by thrombopoietin may also be effective. Because major bleeding in ITP is rare, physicians must be certain that the adverse effects of treatment are not worse than the risks of bleeding caused by ITP.