title: Does treatment of newly diagnosed idiopathic thrombocytopenic purpura reduce morbidity?
abstract: OBJECTIVE
  To explore whether early treatment of children with idiopathic thrombocytopenic purpura (ITP) with immunoglobulin and/or corticosteroids reduces subsequent morbidity.
  
  
  METHODS
  Centres participating in a Nordic ITP study were divided according to whether they had treated more than 2/3, from 1/3 to 2/3, or less than 1/3 children within 14 days of diagnosis. The course of disease from 15 days to 6 months after diagnosis was compared for children managed at the three centre categories. The comparison was restricted to children in whom at least one platelet count <20x10(9)/l was measured, numbering 156, 143 and 84 in the three different categories, respectively.
  
  
  RESULTS
  The three groups of children were clinically similar but were managed with initial treatment rates of 89%, 57% and 14%, respectively. By day 15, the platelet count had stabilised to >20x10(9)/l in 67%, 67% and 52% (p<0.05) and to >150x10(9)/l in 38%, 29% and 29% (p<0.20). At 1 month after diagnosis there was no difference in recovery rates. Chronic ITP developed in 27%, 22% and 25% in the three groups. During follow-up, one or more disease-related events occurred in 23%, 22% and 19%, with no difference in the average numbers of episodes with mucosal bleeding. Treatment courses were administered to 19%, 13% and 11%, respectively.
  
  
  CONCLUSIONS
  Active treatment policies accelerated platelet recovery in children with short-lasting ITP but did not avert the development of chronic ITP and did not cause a reduction in morbidity during follow-up.
authors: Sachs' Children's Hospital, Stockholm, Sweden.
authors: Iris
authors: I
authors: Treutiger
authors: Jukka
authors: J
authors: Rajantie
authors: Bernward
authors: B
authors: Zeller
authors: Jan-Inge
authors: JI
authors: Henter
authors: Göran
authors: G
authors: Elinder
authors: Steen
authors: S
authors: Rosthøj
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D002675:Child, Preschool; D005260:Female; D005387:Finland / Q000453:epidemiology; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D007055:Iceland / Q000453:epidemiology; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010976:Platelet Count; D011446:Prospective Studies; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D012537:Scandinavian and Nordic Countries / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D016756:Immunoglobulins, Intravenous