Table of Contents

HK J Paediatr (New Series)
Vol 2. No. 2, 1997

HK J Paediatr (New Series) 1997;2:179

Proceedings of Scientific Meeting

Treatment Practice of Idiopathic Thrombocytopenia Purpura

V Lee, KW Chik, MK Shing, CK Li, MP Yuen

HK J Paediatr (new series) 1997;2:175-186

Hong Kong Paediatric Society 35th Anniversary Scientific Meeting September 6,1997

Idiopathic thrombocytopenic purpura (ITP) is the commonest childhood bleeding disorder. The rationale for treatment in acute ITP is to avoid the rare life-threatening bleeding event (accounting 0.5-1% of cases, most are due to intracranial haemorrhage) in a blood disorder that has at least 80% chance of spontaneous recovery. There are controversies in the usage of intravenous immunoglobulin (IVIg), systemic steroid or managed conservatively. As the complication rate is low, randomized control studies of various treatment modalities are difficult to carry out. A child with severe thrombocytopenia admitted in the middle of night will usually cause great concern to on-call doctors. It is always tempting to start treatment to increase the 'dangerous' platelet number. IVIg has been emerged as an 'emergency' treatment because of fast action, relatively few side effects, and most important not requiring a bone marrow examination before treatment. This is a retrospective review on the practice of acute management of ITP by various modalities. We reviewed 27 paediatric patients who were newly diagnosed to have ITP during the period Jan., 93 to Dec, 96. 13 of them were managed conservatively with median presenting platelet count 26x109/l (range 5-66). Six had the initial platelet count <20, all but 1 had their platelet count rose above 20 in the median time of 6 days (3-13). Ten had their platelet count rose spontaneously above 100 at the median time of 7.5 days (1^113). One failed to attain a platelet count >20 and subsequently defaulted. Two (15%) failed to attain a platelet count >100 and evolved into chronic ITP. 12 patients, median presenting platelet count 4.5 (1-17), received IVIg as the initial management. On-call medical attendants in 7 cases initiated treatment; haematologists initiated treatment in the other five. Indications of IVIg included mucosal bleeding, very low platelet count, infancy, and suspected head injury. One patient received IVIg 1 gm/kg/dose for two doses; platelet increased to above 100 on the ninth day. Eleven patients received IVIg 400mg/kg/dose for one day with further doses given daily until platelet rose above 20 or maximum dosage of 2gm/kg reached. Seven required 1 dose while the others required 2 to 5 doses of IVIg. All patients attained a platelet count >20 at the median time of 2 days (1-5); only 2 had rapid recovery with platelet rose above 100 within 3 weeks' time. Two had spontaneously recovery at about a month-time, 3 defaulted follow-up and 4 evolved to chronic ITP Only two patients were treated with systemic steroid (prednisolone and methylprednisolone respectively). Both of them had history of bleeding tendency of more than 6 months suggesting chronic ITP at presentation. Both of them only had transient response and finally documented to have chronic ITP. There were no life threatening bleeding event occurred in all our patients. Two third of our patients with platelet less than 20 were treated with IVIg. However, the efficacy of preventing life threatening bleeding could not be assessed. ITP is a common bleeding disorder but runs a benign course in most of the cases. Many patients do not require any specific treatment. Until further strong evidence become available, specific treatment as IVIg should be reserved for selected patients, and a single dose of IVIg may be sufficient.


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