- Thromboytopaenia
- Description
- Diagnostic criteria
- General and supportive measures
- Medicine treatment
- Referral
In addition to the usual causes of blood disorders in childhood, HIV infected children are at increased risk of developing anaemia, thrombocytopaenia and neutropaenia secondary to drugs (especially zidovudine in the case of anaemia), opportunistic infections or neoplasms. They are also at increased risk of thrombo-embolic disease secondary to vasculopathy or the induction of a thrombophilic state.
THROMBOCYTOPAENIA
D69.6
DESCRIPTION
Most cases of thrombocytopaenia in children with HIV infection are due to immune thrombocytopaenic purpura.
Exclude other causes of thrombocytopaenia if the diagnosis is made clinically.
DIAGNOSTIC CRITERIA
Clinical
- Bleeding tendency in a child with HIV infection.
- Asymptomatic finding on full blood count.
Investigations
- Thrombocytopaenia with normal white cell count and red cell indices, apart from the effects of blood loss.
- Normal INR (PT) and partial thromboplastin time (PTT).
- Abundant megakaryocytes on bone marrow aspiration with normal erythroid and myeloid cellularity.
- Indications for bone marrow investigation: Prior to starting steroids or any other abnormality on FBC or any atypical cells on differential count.
GENERAL AND SUPPORTIVE MEASURES
- As for the HIV uninfected child.
- Avoid:
- platelet transfusions, unless life-threatening bleeds;
- contact sport, injury and trauma;
- dental procedures in acute phase;
- medications that affects platelet function, e.g. NSAIDs and aspirin.
- Check for interactions with ARTs.
MEDICINE TREATMENT
As for the HIV uninfected child.
Initiate ART if not already initiated.
Acute ITP
Active bleeding:
- Prednisone, oral, 4 mg/kg/24 hours as a single daily dose for 4 days.
REFERRAL
- All children with refractory symptomatic thrombocytopaenia.