alTP in children is generally a benign disease with a high frequency of spontaneous remission. Nevertheless the risk of life threatening haemorrhage exists as long as the platelet count remains below 20 × 109 / 1. Therefore the debate over treatment versus no treatment is still open.

In order to contribute to solving the problems of therapy of alTP, we reviewed 120 cases of alTP, all of which were diagnosed and treated in the Hematology Division of the “Bambino Gesu” Children's Hospital in Rome. The patients were differently treated at diagnosis: 76 received no treatment, 28 received IVIG at the dosage of 400 mg/kg/d for 5 days, 16 received continuous oral PDN at the dosage of 1-1.5 mg/kg/d for at least two weeks. We found no significant differences as to the percentage of responses among the three groups, but response was faster with IVIG than with PDN at standard dosage.

Conclusions: Aware of the high frequency of spontaneous remission of alTP, the cost of the treatment, the possible side-effects of the therapy, and, on the same time, the risk of possible life-threatening haemorrhages, we conclude that waiting without treatment is safe and appropriate in cases without risk factors for serious life threatening hemorrhages. When treatment is appropriate, or even mandatory because of a very high haemorrhagic risk, standard dose continuous oral steroid therapy, IVIG or high dose steroids may be equally effective as to percentages of responses to treatment, but either IVIG or high dose steroids may achieve a significantly faster rise in the platelet count.