What is idiopathic thrombocytopenic purpura?
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Idiopathic thrombocytopenic purpura (ITP) is a bleeding disorder caused by having too few platelets in the blood. Platelets are small cells in the blood that help to form blood clots, which stop bleeding.
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No one knows exactly why ITP occurs, but the immune system begins to attack its own platelets. It may be triggered by the aftereffects of a viral infection. It often goes away on its own.
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It must be distinguished from more serious conditions. Unlike many conditions discussed in this book, ITP is more likely to develop in a child while in child care or school rather than be a preexisting condition.
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Expected course
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Within 3 months, 75% of patients have recovered.
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By a year, 90% have a normal platelet count.
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A few children go on to have more chronic cases.
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The risk of bleeding may be related to the platelet count.
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What are some characteristics of children with idiopathic thrombocytopenic purpura?
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Idiopathic thrombocytopenic purpura can start with purple bruising (purpura) or a characteristic type of pinpoint bleeding called petechiae.
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Nosebleeds or oral bleeding are also common ways for ITP to present.
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The child may also have blood in the urine or the stools.
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Because it presents as unexplained bruising, there may be a concern about child abuse before the condition is diagnosed. However, ITP is not caused by physical abuse.
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Children generally appear healthy despite their bruises and are often remarkably resistant to bruising despite very low platelet counts
Who is the treatment team?
The treatment team may consist of the primary care provider and a hematologist.
What adaptations may be needed?
Medications
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Many times, no medications need to be given.
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Sometimes ITP is treated with steroids or immune therapy.
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Immune therapy is usually given in a health care setting.
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Steroids can usually be given at home but the side effects of steroids, which include mood changes, increased appetite, nausea, weight gain, and behavior changes, might be seen while the child is in child care or school.
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Rarely, the spleen needs to be removed.
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All children with clotting disorders should avoid nonsteroidal anti-inflammatory drugs such as ibuprofen (with brand names such as Advil or Motrin), naproxen (eg, Aleve), and aspirin.
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Acetaminophen, with brand names such as Tylenol, is usually fine to use, but patients with bleeding disorders should discuss any medications to be taken with their physicians and health care professionals, even over-the-counter medicines.
Dietary considerations
There is no special diet for ITP, but hard foods that could cut the mouth should be avoided.
Physical environment
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Scheduling a visit with parents/guardians before the child returns to the program to review specifics of their child’s condition can be helpful.
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Avoid head trauma and limit climbing. A child with ITP may need to stay home until the condition is under control. Precautions include ensuring straps in high chairs are fastened and sharp corners are padded.
What should be considered an emergency?
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Call emergency medical services/911 for
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Uncontrolled bleeding, including a nosebleed that doesn’t stop after 15 minutes
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Headache
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Inability to move a body part
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Change in behavior
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Difficulty speaking
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Loss of consciousness
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Call parents/guardians for
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Increased bruising
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Minor bleeding that is controlled with first aid
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What types of training or policies are advised?
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First aid to stop bleeding
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Standard precautions
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Background about ITP
What are some resources?
National Heart, Lung and Blood Institute,www.nhlbi.nih.gov
Source: Managing Chronic Health Needs in Child Care and Schools: A Quick Reference Guide.
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The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.