Treatment Strategies and Outcomes in Pediatric Patients With Immune Thrombocytopenia Undergoing Surgical Procedures: A Multicenter Study.

INTRODUCTION

Children with immune thrombocytopenia (ITP) may have an increased risk of perioperative bleeding. However, current pediatric ITP guidelines do not address this management setting. We aimed to describe perioperative management and outcomes in pediatric patients with ITP by platelet count, type of surgery, and ITP-directed treatment strategies.

METHODS

We conducted a retrospective analysis of patients with ITP ages 0-24 years who underwent tooth extraction, tonsillectomy and adenoidectomy, appendectomy, and/or splenectomy at six centers in the United States and Canada between 2019 and 2024.

RESULTS

Fifty-six patients underwent 61 surgeries. Hematology was consulted prior to 89% (49/55) of procedures. Perioperative ITP-directed treatment was prescribed for 52% (32/61) of surgeries. Perioperative treatment was prescribed to 83% (15/18) of patients with preoperative platelet counts <50×109/L, compared with 53% (9/17) with platelet counts 50-99×109/L, and 33% (8/24) with platelet counts ≥100×109/L. At the time of surgery, 93% (56/60) of patients had platelet counts ≥50×109/L. There were two perioperative bleeding events (3%; 2/58), including major bleeding in a patient with a platelet count of 1×109/L where hematology was not involved in perioperative management. Medication side effects were reported in 7% (3/43) of patients receiving ITP-directed therapies.

CONCLUSIONS

In this study of 61 surgeries, 52% of pediatric patients with ITP were given perioperative ITP-directed treatments. Treatment was prescribed for almost half of the patients with an initial platelet count ≥50×109/L. Perioperative bleeding risk appears to be low in pediatric ITP under current management practices.