All issues > Volume 30(8); 1987

Original Article

J Korean Pediatr Soc. 1987;30(8):874-881. Published online August 31, 1987.

A Study on Clinical Course Prognosis and Therapeutic Effect in Childhood ITP.

Sei Woo Chung¹, Don Hee Ahn¹

¹Department of Pediatrics, National Medical Center, Seoul, Korea

Abstract

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.

Keywords :ITP; Steroid treatment; High dose IVIgG