Table 3.
A child with chronic, symptomatic ITP
| Management choice | Responses |
|---|---|
| Anti-D (Win-Rho) | 0 |
| Corticosteroids (daily oral prednisone) | 0 |
| Corticosteroids (intermittent high dose dexamethasone) | 0 |
| IVIg | 0 |
| Observation with no drug treatment (“watchful waiting”) | 0 |
| Rituximab† | 7 |
| Splenectomy†* | 1 |
| Thrombopoietin Receptor Agonists (Nplate [romiplostim], Promacta [eltrombopag]) (if approved and available for use in children) | 3 |
| Other (describe): __________________ | 1** |
**
Other: “IVIg or Win-Rho with steroid burst. If this fails, follow with rituximab.”
Survey question 3. A 6 year-old girl was diagnosed with ITP 12 months ago and continues to have a platelet count of 8,000/μl. During these 12 months she had only transient responses to IVIg and anti-D and recently has had a decline in response to periodic courses of corticosteroids. She has recurrent epistaxis that often requires her to be sent home from school. Her complete blood count and smear review are otherwise normal, and her blood group is A+. What is your management choice?
†
Management recommended by the ICR: Grade B8
*
Management recommended by ASH guideline: Grade1B9