Recommendations for the diagnosis of ITP in children and adults
| Basic evaluation in all patients . | Tests of potential utility in the management of an ITP patient . | Tests of unproven or uncertain benefit* . |
|---|---|---|
| Patient history | Glycoprotein-specific antibody (can be used in difficult cases, has poor sensitivity, and is not a primary diagnostic test) | TPO level |
| Family history | Anti-phospholipid antibodies (including anti-cardiolipin and lupus anticoagulant) if there are clinical features of antiphospholipid syndrome | Reticulated platelets/immature platelet fraction |
| Physical examination | Anti-thyroid antibodies and thyroid function | |
| CBC and reticulocyte count | Pregnancy test in women of childbearing potential | Bleeding time |
| Peripheral blood film | Antinuclear antibodies | Serum complement |
| Quantitative Ig level measurement† | Viral PCR for EBV, CMV, and parvovirus | |
| Blood group (Rh) | Bone marrow examination (in selected patients; refer to text) | |
| HIV‡ | Direct antiglobulin test | |
| HCV‡ | H pylori‡ | |
| HBV |
| Basic evaluation in all patients . | Tests of potential utility in the management of an ITP patient . | Tests of unproven or uncertain benefit* . |
|---|---|---|
| Patient history | Glycoprotein-specific antibody (can be used in difficult cases, has poor sensitivity, and is not a primary diagnostic test) | TPO level |
| Family history | Anti-phospholipid antibodies (including anti-cardiolipin and lupus anticoagulant) if there are clinical features of antiphospholipid syndrome | Reticulated platelets/immature platelet fraction |
| Physical examination | Anti-thyroid antibodies and thyroid function | |
| CBC and reticulocyte count | Pregnancy test in women of childbearing potential | Bleeding time |
| Peripheral blood film | Antinuclear antibodies | Serum complement |
| Quantitative Ig level measurement† | Viral PCR for EBV, CMV, and parvovirus | |
| Blood group (Rh) | Bone marrow examination (in selected patients; refer to text) | |
| HIV‡ | Direct antiglobulin test | |
| HCV‡ | H pylori‡ | |
| HBV |
CMV, cytomegalovirus; EBV, Epstein-Barr virus; PCR, polymerase chain reaction; PTT, partial thromboplastin time; Rh, rhesus; TPO, thrombopoietin.
These tests have no proven role in the differential diagnosis of ITP from other thrombocytopenias and do not guide patient management.
Quantitative Ig level measurement should be considered in children with ITP and is recommended in children with persistent or chronic ITP as part of the reassessment evaluation.
Recommended by the majority of the panel for adult patients in the appropriate geographic setting.