How do we treat acute immune thrombocytopoenia (ITP) in the Maritime provinces? Jennie Lee1, Bruce Crooks1,2 1 Dalhousie University, Halifax, NS, 2IWK Health Center, Halifax, NS Background Immune thrombocytopoenia (ITP) is the commonest bleeding disorder of childhood and is characterized by an isolated low platelet count. ITP is usually self-limiting (80% spontaneously resolve within a year). Many patients are treated to avoid clinically significant, yet rare, bleeding. Published guidelines have differed in recommendations. This study aimed to explore approaches in managing acute ITP at the IWK Health Centre and across the Maritimes. Methods A literature review, retrospective chart review of ITP patients followed at the IWK since 1 January 1990, and an online survey of paediatricians’ practices were conducted. Results Published guidelines are converging and encourage paediatricians to treat based on symptoms not absolute platelet counts. Chart review showed that 99/144 patients received at least one course of treatment – 60/99 with IVIg and 37/99 with corticosteroids The decision to treat 66/99 was on platelet count alone. Bone marrow examinations, recommended in an atypical presentation or prolonged course of disease, were performed in 54 patients. IWK paediatricians relied on clinical experience in 135 cases and consultation with colleagues in 36 cases. 24 Maritime paediatricians who responded to our online questionnaire manage ITP. 17completed the survey.19/24 were uncertain of recommended diagnostic platelet counts for ITP. 2/24 reported using published resources to complete the survey. 13/21 paediatricians reported they would use published guidelines to guide management in provided case scenarios and 17/21 would consult colleagues. Conclusion Actual management of acute ITP differs from published guidelines: patients are treated more for platelet counts and may be over-investigated and over-treated. Lack of adequate documentation may bias results. Maritime paediatricians prefer managing patients collaboratively, but further education is needed. A prospective survey would explore this further.
jennie.lee@dal.ca 50