[Differences in the treatment of idiopathic thrombocytopenic purpura in children].
ABSTRACT Idiopathic thrombocytopenic purpura (ITP) is a rare immune-mediated bleeding disorder that usually takes a self-limiting and benign course. Due to the risk of intracranial haemorrhage, treatment regimens tend to be active. We present treatment data from 17 paediatric departments in Denmark (1998-2000), focusing on regional differences in treatment strategy.
As part of a prospective Nordic study, clinical findings and treatment were recorded for 109 children with newly diagnosed ITP. The course in the following six months was reported for 91 children. Results are compared for three geographical regions: East, North and South.
Pharmacotherapy, almost exclusively intravenous immunoglobulin, was given within 14 days of diagnosis to 89%, 70%, and 48% in regions East, North, and South, respectively. A very low platelet count was the main indication. Platelet transfusion was given to 24%, 0% and 4%, respectively. There were no differences in remission rates or frequency of mucosal bleeding during follow-up, but treatment rates were 6.3, 4.7, and 3.0 per patient-year with severe thrombocytopenia. Chronic ITP lasting more than six months developed in 26%, 33%, and 18%, respectively.
We found obvious regional differences in treatment strategy which reflect differences in international clinical guidelines. The initial treatment approach had no influence on morbidity, time of remission or risk of chronic course.
- SourceAvailable from: Steen Rosthøj[show abstract] [hide abstract]
ABSTRACT: Treatment of newly diagnosed immune thrombocytopenia (ITP) is controversial and guidelines vary internationally. At the Paediatric Department, Aalborg Hospital, a "watchful waiting" approach was adopted in the early 2000s. We aimed to investigate whether this change in strategy had any adverse effects on the subsequent clinical outcomes. Medical records were reviewed for children with ITP presenting with a platelet count < 30 billion/l in the 1990s (n = 22) and in the 2000s (n = 47). Management during the initial admission and events during the first 12 months after diagnosis were recorded. The rate of initial treatment with immunoglobulin or steroids was reduced from 64% in the 1990s to 15% in the 2000s. The percentage of children with ITP lasting more than three months did not increase (30% versus 32%). Nor did the occurrence of ITP lasting > 12 months (15% versus 27%). The proportion of children requiring readmission (19% versus 27%) or receiving therapy during follow-up (19% versus 23%) was unchanged. Serious bleeding requiring immediate intervention was equally rare (one episode in the 1990s, two in the 2000s). Cusum plots usefully depicted the changes in management and confirmed that the rate of adverse events did not increase. A watchful waiting strategy for children with newly diagnosed ITP has been implemented without adverse effects on the duration or the morbidity of ITP.Danish medical bulletin 04/2011; 58(4):A4252. · 0.92 Impact Factor