Abstract
32 of 125 children with newly diagnosed ITP who exhibited marked hemorrhagic manifestations within a week of onset were treated with oral prednisolone (PSL, 13 cases), intravenous immunoglobulin (IVIg, 12 cases) and “Pulse” methylprednisolone (m-PSL “Pulse”, 7 cases). The number of the patients who responded well to these treatment were 10 (77%), 11 (92%) and 5 (71%), respectively. The mean periods in which platelet counts of these patients achieved appreciable elevation (10×104/μl) were 2.6±0.8 day in IVIg, 4.0±0.6 day in m-PSL “Pulse” and 11.9±5.5 day in conventional oral PSL therapy (p<0.001). There was no significant difference in a rate of platelet increase between the casses with oral PSL and those with no treatment, as a whole.
57 of 130 children with chronic ITP investigated by Idiopathic Disorders of Hematopoietic Organ Research Comittee, The Ministry of Health and Welfare of Japan were initially treated with oral PSL at the doses of 1 mg/kg or 2 mg/kg for at least two weeks. Although 23 of 54 patients manifested favorable reaction on this therapy with at least 5×104/μl of platelet increment, they had a tendency to develop thrombocytopenia again along with tapering of PSL except for 8 (14%) patients. 43 of 130 patients were undergone splenectomy in recent 15 years, and they obtained a beneficial response in 29 (67.4%) cases and a relief from hemorrhagic manifestation in 39 (90.7%) cases during long-term follow up studies of 2 to 15 years. On the contrary, in remaining 87 non-splenectomized patients the incidence of reversal of thrombocytopenia was 40.2% and 22 cases were still dependent upon PSL or immunosuppressive regimens. Twenty one patients with steroid-dependent chronic ITP were treated with IVIg and m-PSL “Pulse” which resulted in favorite but transient rise in platelet count. 3 of 17 cases who were treated with IVIg showed so-called long-term response.
From these data it is postulated that IVIg treatment is a most reliable therapeutic measure in the management of acute ITP with severe hemorrhagic manifestation, and in chronic ITP there appears to be no more satisfactory alternative to splenectomy at present.
