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Management of childhood idiopathic thrombocytopenic purpura

In the 16 years that have elapsed since my previous review on childhood ITP (Lilleyman, 1983) there has been no evident change in the morbidity or mortality of the disorder despite the advent of immunoglobulin and other new therapies. Some things have moved on, however. We are slightly less confused about its natural history. We perhaps have a clearer idea about the risks and outcome of intracranial haemorrhage. Clinical guidelines have appeared (Eden & Lilleyman, 1992; George et al, 1996). An international collaborative group of physicians has been established, and a United Kingdom based patient and parent support group has been set up (details available from the author). But the major debates about diagnosis and management rumble on, fuelled by lack of data from large clinical trials and, unlike other rare childhood disorders, the failure to centralize care of even the most difficult cases.