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Arch Dis Child 92:704-707 doi:10.1136/adc.2006.098442
  • Original article

Does treatment of newly diagnosed idiopathic thrombocytopenic purpura reduce morbidity?

  1. Iris Treutiger1,
  2. Jukka Rajantie2,
  3. Bernward Zeller3,
  4. Jan-Inge Henter4,
  5. Göran Elinder1,
  6. Steen Rosthøj5,
  7. for the NOPHO ITP Study Group
  1. 1Sachs’ Children’s Hospital, Stockholm, Sweden
  2. 2Paediatric Department, Jorvi Hospital, University of Helsinki, Finland
  3. 3Paediatric Department, Rikshospitalet, Oslo, Norway
  4. 4Childhood Cancer Research Unit, Department of Woman and Child Health, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
  5. 5Paediatric Department, Aalborg Hospital, Denmark
  1. Correspondence to:
    Dr S Rosthøj
    Paediatric Department, Aalborg Hospital, Reberbansgade, 9100 Aalborg, Denmark; steen.rosthoej{at}rn.dk
  • Accepted 13 April 2007
  • Published Online First 25 April 2007

Abstract

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 <20×109/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 >20×109/l in 67%, 67% and 52% (p<0.05) and to >150×109/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.

Footnotes

  • Published Online First 25 April 2007

  • Competing interests: None.

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