[Use of corticosteroids and immunoglobulins in acute and chronic immune thrombocytopenia in childhood. A clinically oriented treatment concept].
In 80% of children suffering from immune thrombocytopenic purpura, the disease is a self-limited process. Established therapeutic measures are commonly used to effect symptomatic relief. The foremost of these is the administration of immunoglobulins and corticosteroids. A total of 113 children and adolescents with immune thrombocytopenic purpura were examined retrospectively in this study. Of these, 48%, did not require any therapy, 37% were treated with high-dose immunoglobulin, and 15% with prednisolone as first-line treatment of extensive purpura of the skin and the mucous membrane. The time until the thrombocyte count reached 100 G/l was shorter in the treated group than in the one that was not treated (4.5 and 6.0 versus 21 days). 71% of all patients achieved remission in six month. In 29% the disease took a chronic course. Of 33 children with chronic therapy-dependent disease, 7 were splenectomised successfully. Seven further patients continue to live with thrombocyte counts below 20 G/l, of which 4 suffer from recurrent bleeding episodes. In patients with acute and chronic immune thrombocytopenic purpura, the aim of treatment is to prevent potentially fatal bleeding. Patients with thrombocyte counts below 20 G/l are high-risk patients. Nevertheless, even in this group, the therapy should be decided clinically according to bleeding tendency. Ideally, the therapy should result in a quick increase of thrombocyte counts whilst causing minimum side effects. Of the various established treatment modalities, high-dose immunoglobulin and high-dose prednisolone best fulfil these requirements.
Höcker-Schulz
S
S
St. Anna Kinderspital, Wien.
Elstner
T
T
Pawlosky
J
J
Gadner
H
H
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003131:Combined Modality Therapy; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007116:Immunization, Passive; D007223:Infant; D008297:Male; D010976:Platelet Count / Q000187:drug effects; D011239:Prednisolone / Q000008:administration & dosage; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000276:immunology / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D011239:Prednisolone