| A Study on Clinical Course Prognosis and Therapeutic Effect in Childhood ITP. |
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Sei Woo Chung, Don Hee Ahn |
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Department of Pediatrics, National Medical Center, Seoul, Korea |
| 소아 특발성 혈소판 감소성 자반증의 임상경과 예후 및 치료 효과에 관한 검토
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정세우, 안돈희 |
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국립의료원소아과 |
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| Abstract |
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Clinical observations were made on 55 patients of childhood ITP who were diagnosed at the
department of Pediatrics, National Medical Center from January 1977 to April 1986.
Boys were 30 cases and girls were 25 cases.
The following results were obtained.
1) The highest incidence was seen among the children between three and five years of age and the
boys were affected more frequently than girls (1.2: 1). The seasonal peak incidence showed from March to May.
2) In most cases (61.8%), there noted antecedent illness, mostly upper respiratory infection. The
main clinical features were purpura including petechiae and ecchymoses (78.2%), epistaxis (49.1%),
hepatomegaly (41.8%) and anemia (34.5%) in the order of frequency.
3) Thrombocytopenia was seen in all the cases. About half of the cases (52.7%) showed initial
platelet count less than 25,000/mm3. Prolonged bleleding time was seen in 20 cases (36.4%) and the
clotting time was within normal range. Tourniquet test was positive in 40 cases (72.7%).
4) Increased megakaryocytes, erythropoietic activity and eosinophils were seen on bone marrow examination.
5) Effects of steroid treatment of ITP were analyzed. According to the initial platelet count, the
study was divided into 2 groups, and the following results were obtained. Among 29 patients with
their initial platelet count less than 25,000/mm3, 21 received steroid treatment and 8 received
conservative treatment.
① It took 3.4 ± 2.40 days to reach platelet count above 25,000/mm3 in steroid group and 6.0 ±2.83 days in nonsteroid group (p<0.05).
② It took 5.3±2.65 days to reach platelet count above 50,000/mm3 in steroid group and 8.4±1.99 days in nonsteroid group (p<0.01).
③ It took 8.9±2.21 days to reach platelet count above 100,000/mm3 in steroid group and 11.4±1.51 days in nonsteroid group (p<0.05),
④ It took 15.7±2.74 days to reach platelet count above 150,000/mm3 in steroid group and 19.4±1,38 days in nonsteroid group (p<0.01).
6) The results among 26 patients with their initial platelet count more than 25,000/mm3 showed no
difference between 2 groups.
7) High dose IVIgG was performed on 14 month old boy with recurrent ITP who was steroid
dependent. Fiver days infusion of IVIgG (400 mg/kg/day) was done initially. Platelet count began to
rise on the next day reaching peak on the 8th day of therapy. Three times of booster dose were given,
2 weeks, 3 weeks and 5 weeks intervals respectively. The duration of response to the initial IVIgG
therapy correlated well with the platelet increase from pretreatment of peak counts. Significant
potential toxicity, such as anaphylactoid reactions, hepatitis or secondary immunologic disturbances
such as hypogammaglobulinemia, were not seen.
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| Key Words:
ITP, Steroid treatment, High dose IVIgG
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