title: Prospective evaluation of high-cost management of severe chronic ITP in children and adolescents<16 years.
abstract: Chronic ITP rarely presents with severe bleeding episodes (SBE). Number and duration of SBE were evaluated in relation to the cost of management. Out of 157 chronic ITP patients attending our institution from 1994 to 2003, 37 patients, <16 years with persistent thrombocytopenia (>6 months), suffering from SBE or platelet count<10x10(9)/L were prospectively randomized to receive either intravenous immunoglobulins (IVIG), anti-D immunoglobulin (anti-D) or high-dose methyl prednisolone (HDMP). Sixty-one patient-years were followed, during which 351 SBE were documented. The high-cost management (IVIG and anti-D) showed insignificantly better platelet recovery, less frequent SBE with shorter duration per patient, higher rate of CR, and less splenectomy in contrast to the steroid groups. The effectiveness of high-cost management compared with methyl prednisolone could not be documented in this study.
authors.affiliation: Pediatrics Hematology Oncology Department, Ain Shams University, Cairo, Egypt. elalfym@hotmail.com
authors.forename: M S
authors.initials: MS
authors.lastname: ElAlfy
authors.forename: M S
authors.initials: MS
authors.lastname: El Alfy
authors.forename: A S
authors.initials: AS
authors.lastname: Khalifa
mesh_terms: D000293:Adolescent; D002648:Child; D002908:Chronic Disease; D017281:Cost of Illness; D019468:Disease Management; D004334:Drug Administration Schedule; D004534:Egypt; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage / Q000627:therapeutic use*; D007518:Isoantibodies / Q000008:administration & dosage / Q000627:therapeutic use*; D010976:Platelet Count; D011239:Prednisolone / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D011446:Prospective Studies; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics*; D018029:Rho(D) Immune Globulin; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D016756:Immunoglobulins, Intravenous; D007518:Isoantibodies; C061961:RHO(D) antibody; D018029:Rho(D) Immune Globulin; C025429:methyl prednisolonate; D011239:Prednisolone