 Hi, I am Dr. Vinay, Consentant in Pediatric Hematology, Pediatric Oncology and bone marrow transplantation services at Manipal Hospital, Seshwapur. Let's talk about immune tropocytopenia in children or commonly called childhood ITP. As a pediatric hematologist, I see a lot of parents who come to me very anxious and in a panicky state when the child is diagnosed with ITP, the reason is low blood lead counts. ITP, as the name says, is immune mediated destruction of the platelets, wherein the half-life of the circulatory platelets reduces. Usually, the platelet count will be as low as 10,000 or 20,000, however, a typically a child presenting with ITP is well with very trivial bleeds like skin bleeds or some auromucosal bleeds, something like nosebleeds or gum bleeds and often it is self-limiting. The child does not have any fever and there are no constitutional symptoms other than that. Usually, we classify bleeds into two types in ITP, one is called the dry bleeds and the second is called the wet bleeds. Dry bleeds means the one that looks dry, usually the skin bleeds are dry and the wet bleeds are the ones that come from the wet surfaces like nose, gum bleeds or auromucosal surfaces. When we see a low platelet count or a skin bleed in ITP, it is not to be worried because in children, ITP is usually self-resolving. In kids, about 50% of them, the ITP resolves in first three months and these patients, we term it as newly diagnosed ITP. If the low platelet count and the bleeding manifestation continue beyond three months, then we call it as persistent ITP. If it continues beyond 12 months, we call it as chronic ITP. Close to 80% of children recover in the first year of diagnosis of an ITP and that does not require a lot of treatment. It is often said, the patient will remember the side effects of the treatment rather than the disease itself if we extensively treat. However, there is a small subset of ITP patients who would require some chronic or long-term immunomodulatory agents. When should we be worried in a child with ITP? When there is wet bleeds and there is any internal bleeding. The risk of internal bleeding in ITP is as low as 0.5% that is, if we have 200 children with ITP, only one of them can have a major internal bleeding. It's always advisable to meet a pediatric hematologist at the time of diagnosis of an ITP, although not life-threatening bleeds can occur, but still, hematologists will guide you through the course of an ITP till it resolves. What are the treatment modalities that we use for ITP? There is no curative treatment for ITP because the immune system inside the child's body will modulate itself and resolve the ITP. It's only a bridging treatment that is required in most of the cases. The treatment includes something like intravenous immunoglobulin which modulates the immunity and prevents platelet destruction. The other treatment that is commonly used is glucocorticoids, but that should not be used for a long time because of the side effects. Of late, we are using something called platelet-stimulating agents like l-thromboparic or romiplasty, and with these medications, most of the times the platelet count improves and the patient is well. There is nothing like a safe platelet count in ITP. Children with as low as less than 10,000 platelets might not bleed, but at the same time, kids with 20-30,000 platelets might bleed. It is important to treat the symptoms rather than the platelet count and it is more important to understand the disease rather than to be anxious. Thank you.