Assessment of UK practice for management of acute childhood idiopathic thrombocytopenic purpura against published guidelines.

BACKGROUND

Guidelines for management of acute immune thrombocytopenic purpura (ITP) in childhood were published in 1992. Regional audit in 1995 showed substantial variation in clinical practice not related to clinical differences in patient groups, which indicated a need for national audit.

METHODS

Individuals aged from birth to their 16th birthday newly presenting with ITP were identified over 14 months by regular mailing of paediatricians and haematologists for case notification. Information was obtained from follow-up by a detailed questionnaire.

FINDINGS

ITP was clinically mild and benign in 323 (76%) of 427 cases, including 181 (70%) of 260 cases with platelet counts below 10 x 10(9)/L. There were no deaths or intracranial haemorrhages. There was a substantial discrepancy between clinical practice and published guidelines: many children were admitted to hospital and received treatment unnecessarily; there was overuse of intravenous immunoglobulin (IVIg) as first-line therapy (94 children); children received steroids without marrow examination; and there was inappropriate use of platelet transfusions (41 with mild or moderate disease).

INTERPRETATION

Our results indicate a need for change in practice.