Management of ITP by watchful waiting or observation is a strategy often used for ITP in children. It is also used by some adults with ITP. In watchful waiting, the person with ITP is given no conventional treatment. However, it is not a passive approach or employed without serious consideration.
Watchful Waiting in Children
Watchful waiting is often considered for children because they have a higher rate of spontaneous remission, the incidence of intracranial hemorrhage is low, and the treatments can cause problems. The decision to treat or not to treat is one made by the family along with a hematologist. Many factors go into making the observation decision including the platelet count, bleeding symptoms, quality-of-life for the family and the child, and the child’s activity level. In all cases, it is important for the family to be able to recognize and have a plan for a bleeding emergency.
The American Society of Hematology ITP Guidelines state, "Children with no bleeding or mild bleeding (defined as skin manifestations only, such as bruising and petechiae) be managed with observation alone regardless of platelet count"
Watchful Waiting in Adults
This strategy is often employed by adults who have a low, but safe platelet count. It is also used by some adults who have tried many treatments without success. In any case, it is important for the adult with ITP who chooses observation to have a thorough understanding of the symptoms of a dangerously low platelet count and have a plan to deal with a bleeding emergency.