CONTENTS:
Each month, PDSA highlights interesting findings and insightful expert commentary to help enhance your understanding of ITP and partner more effectively with your care team. This month, we share the following:
Pediatric ITP and Surgery
By Matthew Meuler, Medical Student, and Kirsty Hillier, MD, Pediatric Hematology/Oncology Faculty, Department of Pediatrics, Division of Pediatric Hematology-Oncology, Hassenfeld Children’s Hospital at NYU Langone Health, NYU Grossman School of Medicine, New York, NY
Children with immune thrombocytopenia (ITP) experience immune-mediated platelet destruction, leading to lower platelet counts and an increased risk of bleeding and bruising. This risk is further elevated when a child with ITP requires surgery, given that all surgical procedures carry an inherent bleeding risk. Therefore, careful management of pediatric ITP is especially important around the time of surgery to avoid adverse bleeding events.
The American Society of Hematology (ASH) generally recommends conservative management of pediatric ITP, with a focus on treating symptoms as they arise. However, there are currently no established United States guidelines that address children with ITP undergoing surgery. This can lead to a variability in treatment strategies for pediatric ITP, which can then result in children being under- or over-treated for their ITP or experiencing potential differences in outcomes.
Researchers at NYU Grossman School of Medicine recognized that doctors do not have clear, evidence-based guidance for management of pediatric ITP around the time of surgery. Together with the ITP Consortium of North America (ICON) a group of pediatric hematologists across the continent with a shared mission to learn more about ITP through research they designed a study to address this knowledge gap. The goal was to better understand how children with ITP undergoing surgery are currently being treated, so that data from this study could one day inform future guidelines. Such guidelines could help doctors better manage pediatric ITP around the time of surgery.
In addition to NYU, five other hospitals across the United States and Canada were included to strengthen the results from the study. The medical centers included NYU Grossman School of Medicine, Children’s Hospital of Eastern Ontario, Centre Hospitalier Universitaire in Montreal, Children’s Hospital of Philadelphia, Medical College of Wisconsin, and Boston Children’s Cancer and Blood Disorders Center. The researchers examined the medical records of children with ITP who had recently undergone four common surgical procedures: appendectomy (removal of the appendix), splenectomy (removal of the spleen), tonsillectomy and adenoidectomy (removal of the tonsils and adenoids), and/or dental extraction. They gathered information about the types of treatment given, platelet levels, and outcomes after surgery.
In this study, a total of 56 patients underwent 61 surgeries. About half of the patients received some form of ITP treatment added for surgery, and nearly half of those who got treatment had platelet levels that were moderately low (50-100k) or higher. Only two patients experienced bleeding events after procedures, one with a severely low (<50k) platelet level and one with a moderately low platelet level. The findings showed that children with higher platelet counts are likely at a lower risk of bleeding associated with surgery. In other words, perioperative bleeding risk appears to be low in pediatric ITP under current management practices. It is also very important to have coordination and communication between hematologists, surgeons, and dentists prior to procedures in this population.
This study is only the beginning of what researchers with ICON hope will be a movement to better understand and treat pediatric ITP. Universal guidelines will be important to ensure children with ITP receive the best care possible.
In light of this work, a recent research article was published in Pediatric Blood and Cancer (M.Ross, L.Phillips, K.Pierce, et al. Treatment Strategies and Outcomes in Pediatric Patients With Immune Thrombocytopenia Undergoing Surgical Procedures: A Multicenter Study. Pediatric Blood & Cancer (2026): e70283. https://doi.org/10.1002/1545-5017.70283)
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