title: Efficacy of combined intravenous immunoglobulins and steroids in children with primary immune thrombocytopenia and persistent bleeding symptoms.
abstract: BACKGROUND
  The aim of this study was to investigate the effect of the combined administration of intravenous immunoglobulins and steroids as a second-line therapy in 34 children with primary immune thrombocytopenia and persistent, symptomatic bleeding.
  
  
  METHODS
  Combined therapy (intravenous immunoglobulins 0.4 g/kg daily on days 1 and 2, and methylprednisolone 20 mg/kg daily on days 1-3) was administered to 12 patients with newly diagnosed ITP who did not respond to the administration of a single therapy (either intravenous immunoglobulins or steroids) and to 22 children with persistent and chronic disease who required frequent administrations (i.e. more frequently than every 30 days) of either immunoglobulins or steroids (at the same standard dosages) in order to control active bleeding.
  
  
  RESULTS
  A response (i.e. platelet count >50×10(9)/L and remission of active bleeding) was observed in 8/12 (67%) patients with newly diagnosed ITP. The clinical presentation of responders and non-responders did not differ apparently. Patients in the chronic/persistent phase of disease had a significantly longer median period of remission from symptoms compared with the previous longest period of remission (p=0.016). The treatment was well tolerated.
  
  
  CONCLUSIONS
  Our data suggest that the combined approach described is a well-tolerated therapeutic option for children with primary immune thrombocytopenia and persistent bleeding symptoms that can be used in both emergency and/or maintenance settings.
authors.affiliation: Paediatric and Neonatology Unit, Ordine Mauriziano Hospital, Torino, Italy Haematology Unit, Department of Paediatric Sciences, University of Turin, Turin, Italy.
authors.forename: Emilia
authors.initials: E
authors.lastname: Parodi
authors.affiliation: Department of Biomedicine of the Developmental Age, Paediatric Unit, University of Bari, Bari, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Giordano
authors.affiliation: Haematology Unit, Department of Paediatric Sciences, University of Turin, Turin, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Rivetti
authors.affiliation: Department of Mathematics, University of Turin, Turin, Italy.
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Giraudo
authors.affiliation: Haematology Unit, Department of Paediatric Sciences, University of Turin, Turin, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Ansaldi
authors.affiliation: Haematology Unit, Department of Paediatric Sciences, University of Turin, Turin, Italy.
authors.forename: Mirella
authors.initials: M
authors.lastname: Davitto
authors.affiliation: Haematology Unit, Department of Paediatric Sciences, University of Turin, Turin, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Mondino
authors.affiliation: Oncology Department, Paediatric Haematology and Oncology Unit, A.R.N.A.S. Ospedale Civico Di Cristina e Benefratelli, Palermo, Italy.
authors.forename: Piero
authors.initials: P
authors.lastname: Farruggia
authors.affiliation: Paediatric Unit, Umberto I Hospital, Nocera Inferiore, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Amendola
authors.affiliation: Paediatric Department, II University of Naples, Naples, Italy.
authors.forename: Sofia M R
authors.initials: SM
authors.lastname: Matarese
authors.affiliation: Paediatric Department, II University of Naples, Naples, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Rossi
authors.affiliation: Paediatric Department, University of Catania, Catania, Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Russo
authors.affiliation: Haematology Unit, Department of Paediatric Sciences, University of Turin, Turin, Italy.
authors.forename: Ugo
authors.initials: U
authors.lastname: Ramenghi
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects; D006470:Hemorrhage / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage* / Q000009:adverse effects; D007155:Immunologic Factors / Q000008:administration & dosage* / Q000009:adverse effects; D007223:Infant; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage* / Q000009:adverse effects; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000150:complications / Q000188:drug therapy*
chemical_list: D005938:Glucocorticoids; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D008775:Methylprednisolone