title: Initial Management of Childhood Acute Immune Thrombocytopenia: Single-Center Experience of 32 Years.
abstract: Immune thrombocytopenia (ITP) is an acute self-limited disease of childhood, mostly resolving within 6 months irrespective of whether therapy is given or not. Treatment options when indicated include corticosteroids, intravenous immune globulin (IVIG), and anti-RhD immunoglobulin. We reviewed our 32 years' experience for first-line therapy of acute ITP. Five hundred forty-one children (mean age: 5.3 years) diagnosed and treated for ITP were evaluated retrospectively. Among 491 acute ITP patients, IVIG was used in 27%, high-dose steroids in 27%, low-dose steroids in 20%, anti-D immunoglobulin G (IgG) in 2%, and no therapy in 22%. When the initial response (platelets >50 × 10(9)/L) to first-line treatment modalities were compared, 89%, 84%, and 78% patients treated by low-dose steroids, high-dose steroids, and IVIG responded to treatment, respectively (P > .05). Mean time to recovery of platelets was 16.8, 3.8, and 3.0 days in patients treated with low-dose steroids, high-dose steroids, and IVIG, respectively (P < .0001). Thrombocytopenia recurred in 23% of low-dose steroid, 39% of high-dose steroid, and in 36% of IVIG (P < .0001) treatment groups. Of 108 patients who were observed alone, 4 (3%) had a recurrence on follow-up and only 2 of these required treatment subsequently. Recurrence was significantly less in no therapy group compared with children treated with 1 of the 3 options of pharmacotherapy (P < .0001). Response rates were similar between patients treated by IVIG and low- and high-dose steroids; however, time to response was slower in patients treated with low-dose steroids compared with IVIG and high-dose steroids.
authors.affiliation: a Department of Pediatric Hematology-Oncology, Cerrahpasa Medical Faculty , Istanbul University , Istanbul , Turkey.
authors.forename: Inci
authors.initials: I
authors.lastname: Yildiz
authors.affiliation: a Department of Pediatric Hematology-Oncology, Cerrahpasa Medical Faculty , Istanbul University , Istanbul , Turkey.
authors.forename: Nihal
authors.initials: N
authors.lastname: Ozdemir
authors.affiliation: a Department of Pediatric Hematology-Oncology, Cerrahpasa Medical Faculty , Istanbul University , Istanbul , Turkey.
authors.forename: Tiraje
authors.initials: T
authors.lastname: Celkan
authors.affiliation: a Department of Pediatric Hematology-Oncology, Cerrahpasa Medical Faculty , Istanbul University , Istanbul , Turkey.
authors.forename: Selen
authors.initials: S
authors.lastname: Soylu
authors.affiliation: a Department of Pediatric Hematology-Oncology, Cerrahpasa Medical Faculty , Istanbul University , Istanbul , Turkey.
authors.forename: Serap
authors.initials: S
authors.lastname: Karaman
authors.affiliation: a Department of Pediatric Hematology-Oncology, Cerrahpasa Medical Faculty , Istanbul University , Istanbul , Turkey.
authors.forename: Aylin
authors.initials: A
authors.lastname: Canbolat
authors.affiliation: a Department of Pediatric Hematology-Oncology, Cerrahpasa Medical Faculty , Istanbul University , Istanbul , Turkey.
authors.forename: Omer
authors.initials: O
authors.lastname: Dogru
authors.affiliation: b Department of Public Health, Cerrahpasa Medical Faculty , Istanbul University , Istanbul , Turkey.
authors.forename: Ethem
authors.initials: E
authors.lastname: Erginoz
authors.affiliation: a Department of Pediatric Hematology-Oncology, Cerrahpasa Medical Faculty , Istanbul University , Istanbul , Turkey.
authors.forename: Hilmi
authors.initials: H
authors.lastname: Apak
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000008:administration & dosage*; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage*; D007223:Infant; D008297:Male; D010976:Platelet Count; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000097:blood / Q000188:drug therapy*; D020127:Recovery of Function / Q000187:drug effects; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D000305:Adrenal Cortex Hormones; D007074:Immunoglobulin G; D016756:Immunoglobulins, Intravenous
keywords: bleeding diathesis; childhood; immune thrombocytopenia; thrombocytopenia