ORIGINAL ARTICLE

¹ Sachs’ Children’s Hospital, Stockholm, Sweden
² Paediatric Department, Jorvi Hospital, University of Helsinki, Finland
³ Paediatric Department, Rikshospitalet, Oslo, Norway
⁴ Childhood Cancer Research Unit, Department of Woman and Child Health, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
⁵ Paediatric Department, Aalborg Hospital, Denmark

Correspondence to:
Correspondence to:
Dr S Rosthøj
Paediatric Department, Aalborg Hospital, Reberbansgade, 9100 Aalborg, Denmark; steen.rosthoej{at}rn.dk

Aim: To explore whether early treatment of children with idiopathic thrombocytopenic purpura (ITP) with immunoglobulin and/or corticosteroids reduces subsequent morbidity.

Methods: Centres participating in a Nordic ITP study were divided according to whether they had treated more than 2/3, from 1/3 to 2/3, or less than 1/3 children within 14 days of diagnosis. The course of disease from 15 days to 6 months after diagnosis was compared for children managed at the three centre categories. The comparison was restricted to children in whom at least one platelet count <20x10⁹/l was measured, numbering 156, 143 and 84 in the three different categories, respectively.

Results: The three groups of children were clinically similar but were managed with initial treatment rates of 89%, 57% and 14%, respectively. By day 15, the platelet count had stabilised to >20x10⁹/l in 67%, 67% and 52% (p<0.05) and to >150x10⁹/l in 38%, 29% and 29% (p<0.20). At 1 month after diagnosis there was no difference in recovery rates. Chronic ITP developed in 27%, 22% and 25% in the three groups. During follow-up, one or more disease-related events occurred in 23%, 22% and 19%, with no difference in the average numbers of episodes with mucosal bleeding. Treatment courses were administered to 19%, 13% and 11%, respectively.

Conclusion: Active treatment policies accelerated platelet recovery in children with short-lasting ITP but did not avert the development of chronic ITP and did not cause a reduction in morbidity during follow-up.

Abbreviations: CS, corticosteroids; ITP, idiopathic thrombocytopenic purpura; IVIG, intravenous immunoglobulin

Keywords: idiopathic thrombocytopenic purpura; immunoglobulin therapy; corticosteroid therapy

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