[Immune thrombocytopenic purpura in children--controversy and consensus. How much investigation and treatment is meaningful?].

Immune thrombocytopenic purpura (ITP) is a postinfectious thrombocytopenia with a general tendency to bleed. The disease is often self-limiting in children, but the risk of intracranial haemorrhage has led to some controversy about indications and intensities of treatment. In nearly all cases of intracranial haemorrhage documented in the literature since 1970, the platelet count was 15 x 10(9)/l) or lower and was observed in less than 1% of the patients. In typical cases of acute ITP no extensive laboratory investigation is required. Indications for treatment depend more on clinical bleeding symptoms than on platelet count. Up to now there is no proven difference in efficacy between steroids and immunoglobulins. In 10-25% the disease becomes chronic, but spontaneous remission can occur after many years. Management of the chronic form has to be adjusted to the individual patient. Continuous steroid treatment for more than three weeks is contraindicated. Splenectomy should be avoided if at all possible because the risk of sepsis after splenectomy is comparable with the risk of life-threatening bleeding.