Trombocitopenia Imune na População Pediátrica:

Revisão de Literatura com Proposição de Recomendações para a Santa Casa de Misericórdia de Sobral/CE

Abstract

Introduction: Immune Thrombocytopenia (ITP) is an acquired autoimmune disorder characterized by isolated thrombocytopenia resulting from autoantibody-mediated platelet destruction and impaired megakaryocytopoiesis. In the pediatric population, its incidence reaches up to 6.4 cases per 100,000 individuals, with a predominantly self-limited course, although a subgroup of patients progresses to persistent or chronic forms associated with a significant risk of bleeding. Objective: To analyze the current scientific evidence regarding the diagnosis and management of pediatric ITP and to propose clinical care recommendations for the practice of the Santa Casa de Misericórdia de Sobral (SCMS). Method: Narrative literature review conducted through searches in the PubMed/MEDLINE and Embase databases, using the PICo strategy to formulate the guiding research question. Full-text articles published in English between 2021 and 2026 were included, complemented by the Brazilian Ministry of Health Clinical Protocol and Therapeutic Guidelines (2025). Results and Discussion: The diagnosis of ITP is essentially clinical and one of exclusion, based on complete blood count with peripheral blood smear, serological screening, and targeted investigation to rule out secondary causes of thrombocytopenia. Therapeutic management is guided by bleeding severity and platelet count: watchful waiting is appropriate for most children with isolated cutaneous manifestations, whereas corticosteroids and intravenous immunoglobulin (IVIg) constitute first-line pharmacological therapy. Rituximab and thrombopoietin receptor agonists (TPO-RAs), such as eltrombopag and romiplostim, recently incorporated into the Brazilian Unified Health System (SUS), represent important advances for persistent and chronic forms. Based on these findings, clinical care recommendations adapted to the SCMS context were developed. Final Considerations: The standardization of diagnostic and therapeutic approaches, grounded in the best available evidence, is essential to reduce clinical variability and improve outcomes for pediatric patients with ITP treated at the institution.