Successful implementation of a watchful waiting strategy for children with immune thrombocytopenia.

Introduction: Treatment of newly diagnosed immune thrombocytopenia (ITP) is controversial and guidelines vary internationally. At the Paediatric Department, Aalborg Hospital, a "watchful waiting" approach was adopted in the early 2000s. We aimed to investigate whether this change in strategy had any adverse effects on the subsequent clinical outcomes.

Material and methods: Medical records were reviewed for children with ITP presenting with a platelet count < 30 billion/l in the 1990s (n = 22) and in the 2000s (n = 47). Management during the initial admission and events during the first 12 months after diagnosis were recorded.

Results: The rate of initial treatment with immunoglobulin or steroids was reduced from 64% in the 1990s to 15% in the 2000s. The percentage of children with ITP lasting more than three months did not increase (30% versus 32%). Nor did the occurrence of ITP lasting > 12 months (15% versus 27%). The proportion of children requiring readmission (19% versus 27%) or receiving therapy during follow-up (19% versus 23%) was unchanged. Serious bleeding requiring immediate intervention was equally rare (one episode in the 1990s, two in the 2000s). Cusum plots usefully depicted the changes in management and confirmed that the rate of adverse events did not increase.

Conclusion: A watchful waiting strategy for children with newly diagnosed ITP has been implemented without adverse effects on the duration or the morbidity of ITP.