Changing Trends in ITP Management from 1995 to 2007: An Interim Report from the UK Paediatric ITP Registry.

A UK national paediatric ITP registry (www.uk-itp.org) was set up in January 2007 designed to collect data from all newly diagnosed ITP over at least a subsequent 10 year period. By May 2008, 62 hospitals had recruited 114 children. Details about epidemiology, presentation and management were entered into the registry. The preliminary data presented was compared with results from two national UK audits in 1995 and 2000.

In this first analysis, 68% children had mild, 29% had moderate and 3% had severe disease as defined by a modified Buchanan bleeding score. The mean platelet counts at diagnosis for the groups were 18.3, 10.1 and 8.0 respectively. Bruising (mean 86.7%) and purpura (mean 73.0%) were the most common bleeding manifestations in ITP followed by epistaxis (mean 22.0%) and oral bleeding (mean 18.7%). Other bleeding sites such as bleeding from the gastrointestinal tract and menorrhagia are much less common and there were no intracranial bleeds. Children with mild disease have fewer bleeding sites (mean 1.3), compared to 2.3 with moderate and 3.0 for severe disease. These data are very similar to those reported in the previous national audits.

The proportion of children receiving platelet raising treatment was noted to decrease from 60.5% in 1995 to 37.8% in 2000. The current 2007 registry data shows a continued decrease in treatment to 20% of all the children. In the mild category 11.8% were treated, compared to 31% of the moderate and all of the severe. Of those receiving treatment 75% were treated with steroids alone, 15% IVIG alone and 10% received combination IVIG and steroids. Forty seven percent were admitted to hospital with a median duration of stay at 2 days. In summary the current UK Paediatric ITP Registry data shows similar epidemiological data to the previous UK audits. The previous observed decrease in treatment and adoption of a “watch and monitor” policy has increased to the extent that 80% of children do not receive platelet raising therapy. Continued recruitment and analysis is required to provide more data on which patients can safely avoid platelet raising therapy and which patients require prompt treatment to raise their platelet count.