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Chronic childhood idiopathic thrombocytopenia purpura: long‐term follow‐up
Author(s) -
Tamary H,
Kaplinsky C,
Levy I,
Cohen IJ,
Yaniv I,
Stark B,
Goshen Y,
Zaizov R
Publication year - 1994
Publication title -
acta pædiatrica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.772
H-Index - 115
eISSN - 1651-2227
pISSN - 0803-5253
DOI - 10.1111/j.1651-2227.1994.tb13175.x
Subject(s) - medicine , prednisone , splenectomy , thrombocytopenic purpura , retrospective cohort study , purpura (gastropod) , surgery , pediatrics , spontaneous remission , complete remission , platelet , chemotherapy , spleen , ecology , alternative medicine , pathology , biology
An understanding of the natural history of childhood chronic idiopathic thrombocytopenia purpura (ITP) could contribute to a rational therapeutic approach to its treatment, which remains controversial. In our retrospective study of 92 children with ITP, 22 had a chronic course and were followed for 3–14 years (median 8.6 years). Treatment, when indicated, was individualized: 4 patients (18.2%) did not receive any treatment, 14 (63.6%) received steroids only, while 4 (18.2%) were treated with steroids and one of the following: high‐dose gamma globulin (4 patients), splenectomy (2 patients) or immunosuppressive therapy (2 patients). During follow‐up, 14 patients (63.6%) achieved complete remission, 5 (22.7%) partial remission and only 3 (13.5%) remained severely thrombocytopenic, with minimal bleeding tendency. Eleven patients (50%) responded to the initial prednisone course (1–5mg/kg/day), but showed a marked decrease in platelet count when steroids were tapered off. In view of the high rates of complete and partial remission and the mild course of the few non‐responding patients, it is suggested that with adequate supportive therapy, follow‐up problems and fatalities can be kept to a minimum. We believe that aggressive therapy, such as splenectomy, should be reserved for the rare symptomatic and severely thrombocytopenic patient.