Chronic childhood idiopathic thrombocytopenia purpura: long-term follow-up.
An understanding of the natural history of childhood chronic idiopathic thrombocytopenia purpura (ITP) could contribute to a rational therapeutic approach to its treatment, which remains controversial. In our retrospective study of 92 children with ITP, 22 had a chronic course and were followed for 3-14 years (median 8.6 years). Treatment, when indicated, was individualized: 4 patients (18.2%) did not receive any treatment, 14 (63.6%) received steroids only, while 4 (18.2%) were treated with steroids and one of the following: high-dose gamma globulin (4 patients), splenectomy (2 patients) or immunosuppressive therapy (2 patients). During follow-up, 14 patients (63.6%) achieved complete remission, 5 (22.7%) partial remission and only 3 (13.5%) remained severely thrombocytopenic, with minimal bleeding tendency. Eleven patients (50%) responded to the initial prednisone course (1-5 mg/kg/day), but showed a marked decrease in platelet count when steroids were tapered off. In view of the high rates of complete and partial remission and the mild course of the few non-responding patients, it is suggested that with adequate supportive therapy, follow-up problems and fatalities can be kept to a minimum. We believe that aggressive therapy, such as splenectomy, should be reserved for the rare symptomatic and severely thrombocytopenic patient.
Tamary
H
H
Sambur Center for Pediatric Hematology-Oncology, Children's Medical Center of Israel, Beilinson Medical Campus, Petah Tiqva, Israel.
Kaplinsky
C
C
Levy
I
I
Cohen
I J
IJ
Yaniv
I
I
Stark
B
B
Goshen
Y
Y
Zaizov
R
R
D002648:Child; D002908:Chronic Disease; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007165:Immunosuppression Therapy; D008297:Male; D011241:Prednisone / Q000627:therapeutic use*; D011379:Prognosis; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000628:therapy*; D012074:Remission Induction; D012075:Remission, Spontaneous; D012189:Retrospective Studies; D013156:Splenectomy; D013997:Time Factors; D016896:Treatment Outcome
D016756:Immunoglobulins, Intravenous; D011241:Prednisone