Long-term follow-up study of 168 patients with immune thrombocytopenia. Implications for therapy.
A total of 168 patients (90 adults, 78 children) with immune thrombocytopenia (ITP) and a median follow-up of 75 months were treated with a sequential regimen of corticosteroids (n = 125), splenectomy (n = 83) and immunosuppressives (n = 25). In 43 patients an observation period of a minimum of 1 month preceded the therapy. It is concluded that: (i) withholding therapy in the expectation of spontaneous recovery is at least in children justified in case of limited bleeding tendency; (ii) corticosteroids should be limited in adults to a maximum of 3 weeks and in children to a maximum of 6 weeks; (iii) if corticosteroids fail, splenectomy remains the therapy of choice, especially in patients aged less than or equal to 30 years, and should be performed within 6 months after diagnosis; (iv) after failure of the aforementioned forms of therapy, there is rarely a beneficial effect of treatment with azathioprine and vincristine; (v) no reaction to any form of therapy can be followed by an acceptable long-term outcome.
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008134:Long-Term Care; D008297:Male; D010976:Platelet Count; D012075:Remission, Spontaneous; D013156:Splenectomy; D013921:Thrombocytopenia / Q000097:blood / Q000188:drug therapy* / Q000628:therapy
D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents