Chronic immune thrombocytopenic purpura in children overview of 60 patients

Background: A small percentage of children with Immune thrombocytopenic purpura (ITP) suffer from a clinically significant disease with severe thrombocytopenia that requires intervention. Treatment for these children presents a challenge as there are few known therapies that offer long-term remission, and all that are known have significant side effects and toxicities. Aim of the study: To evaluate the effects of a variety of treatment modalities on the clinical course, and long treatment outcomes in children with chronic ITP. Patients & methods: A study involved 60 children with chronic ITP who were referred to Hemato-Oncology unit/Children's Welfare Teaching Hospital/Medical City/Baghdad. Treatment of patients included steroid, Intravenous Immunoglobulins, Anti D immunoglobulin, 6-Mercaptopurine, Rituximab and splenectomy. The Period of data collection and analysis was from May 2009 to May 2011. Results: The most common presenting symptom was skin bleeding, seen in 42 (70%) patients. Thirty-four patients received one or more courses of steroids. Complete response was achieved in 7 (20.5%) patients while there was no response in 12 (35.2%) patients, Intravenous immunoglobulin was used for 5 patients, only one (16%) exhibited a good response. Anti D Immunoglobulin was used in six patients; only one (8.3%) patient got good response. Twelve patients received 6-mercaptopurine, only one (8.3%) patient had a partial response. Six patients received Rituximab; three (50%) had a partial response. Six patients underwent splenectomy; response was noted in 5/6 (83.3%) patients. At the end of the study; complete response was seen in 13 (22.4%) patients, partial in 19 (31.6%), no response in 28 (46.7%) patients. Conclusions: Splenectomy is the most effective treatment modality when treating children with chronic ITP whose symptoms are severe.