Initial Management of Childhood Acute Immune Thrombocytopenia: Single-Center Experience of 32 Years

• Published in: Pediatric hematology and oncology 2015-08, Vol.32 (6), p.406-414
• Main Authors: Yildiz, Inci, Ozdemir, Nihal, Celkan, Tiraje, Soylu, Selen, Karaman, Serap, Canbolat, Aylin, Dogru, Omer, Erginoz, Ethem, Apak, Hilmi
• Format: Article
• Language: English
• Subjects: Adrenal Cortex Hormones - administration & dosage; bleeding diathesis; Child; Child, Preschool; childhood; Female; Humans; immune thrombocytopenia; Immunoglobulin G - administration & dosage; Immunoglobulins, Intravenous - administration & dosage; Infant; Male; Platelet Count; Purpura, Thrombocytopenic, Idiopathic - blood; Purpura, Thrombocytopenic, Idiopathic - drug therapy; Recovery of Function - drug effects; Retrospective Studies; thrombocytopenia; Time Factors
• ISSN: 0888-0018; 1521-0669
• DOI: 10.3109/08880018.2015.1040931

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.