Main Article Content
There are many clinical practice guidelines in newly diagnosed immune thrombocytopenia (nITP), treatment options are based on clinicians’ decision. The different treatment have different outcomes and complications. Objective: To evaluate treatment outcomes and the incidence of chronic ITP (cITP) among different treatments. Materials and Methods: We reviewed the patients’ medical records diagnosed with nITP aged 3 months to 15 years at Siriraj hospital between 2006-2010. Results: Ninety seven patients were treated in 5 different treatment strategies, observation (obs) 13.4%, prednisolone 2 mg/kg/day (P2) 24.8%, prednisolone 4 mg/kg/day (P4) 27.8%, pulse methylprednisolone (MP) 5.1% and intravenous immunoglobulin (IVIG) 28.8%. The median response time were in obs: 55, P2: 15, P4: 12, MP 12 and IVIG 3 days. In IVIG group was significantly faster than in obs and P2 (p = 0.002 and 0.01) and in P4 is significantly faster than obs (p = 0.03) but those between other groups were not significant. Sixty four patients completed 1 year follow up and 28.1% developed cITP: 71.4% in obs, 40% in P2, 26.3% in P4, 20% in MP, and 5.6% in IVIG group developed cITP. The patients with cITP in IVIG group is lower than in obs and P2 significantly (P = 0.002 and 0.03) but in between the other groups were not significant. Conclusion: The response time in IVIG group is faster than obs, P2 and P4. The incidence of cITP in IVIG is lower than in obs and P2 group. The results may be applied to treatment for each patients’ condition.
2. Rodeghiero F, Stasi R, Gernsheimer T, Michel M, Provan D, Arnold DM, et al. Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood. 2009;113:2386-93.
3. Provan D, Stasi R, Newland AC, Blanchette VS, Bolton-Maggs P, Bussel JB, et al. International consensus report on the investigation and management of primary immune thrombocytopenia. Blood. 2010;115:168-86.
4. Neunert C, Lim W, Crowther M, Cohen A, Solberg L Jr, Crowther MA; American Society of Hematology. The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia. Blood. 2011;117:4190-207.
5. Satthawisut S, Kanjanapongkul S. 12-year Retrospective review of immune thrombocytopenic purpura in the Queen Sirikit National Institute of Child Health Hospital (QSNICH). J Hematol Transfus Med 2012;22:259-67.
6. Shirahata A, Fujisawa K, Ishii E, Ohtaa S, Sako M, Takahashi Y, et al. A nationwide survey of newly diagnosed childhood idiopathic thrombocytopenic purpura in Japan. J Pediatr Hematol Oncol 2009;31:27-32.
7. Zafar H, Anwar S, Faizan M, Riaz S. Clinical features and outcome in paediatric newly diagnosed immune thrombocytopenic purpura in a tertiary care centre. Pak J Med Sci. 2018;34:1195-9.
8. Bennett CM, Cindy Neunert C, Grace RF, Buchanan G, Imbach P, Vesely SK, et al. Predictors of remission in children with newly diagnosed immune thrombocytopenic: Data from the Intercontinental Cooperative ITP Study Group Registry II participants. Pediatr Blood Cancer. 2018;65:e26736. doi: 10.1002/pbc.26736.
9. Blanchette V, Imbach P, Andrew M, Adams M, McMillan J, Wang E, et al. Randomised trial of intravenous immunoglobulin G, Intravenous anti-D, and oral prednisone in childhood acute immune thrombocytopenic purpura. Lancet. 1994; 344:703-7.
10. Blanchette V, Carcao M. Approach to the investigation and management of immune thrombocytopenic purpura in children. Semin Hematol. 2000; 37:299-314.
11. Chotsampancharoen T, Sripornsawan P, Duangchoo S, Wongchanchailert M, McNeil E. Clinical outcome of childhood chronic immune thrombocytopenia: A 38-year experience from a single tertiary center in Thailand. Pediatr Blood Cancer. 2017;64. doi: 10.1002/pbc.26598.
12. Champatiray J, Behera DK, Krishnamoorthy A, Bhat S. Evaluation of prevalence, clinical spectrum and outcome of acute ITP in children in a tertiary care centre in Odisha, India. Int J Contemp Pediatr. 2017;4:1470-5.
13. Mushtaq N, Alam MA, Fadoo Z. Idiopathic thrombocytopenic purpura in children: A 10 years’ experience at tertiary care hospital. J Pak Med Assoc.2014;64:1358-62.
14. Heitink-Pollé KM, Nijsten J, Boonacker CW, de Haas M, Bruin MC. Clinical and laboratory predictors of chronic immune thrombocytopenia in children: a systematic review and meta-analysis. Blood. 2014;124:3295-307.
15. Heitink-Pollé KMJ, Uiterwaal CSPM, Porcelijn L, Tamminga RYJ, Smiers FJ, van Woerden NL, et al; TIKI Investigators. Intravenous immunoglobulin vs. observation in childhood immune thrombocytopenia: a randomized controlled trial. Blood. 2018;132:883-91.