Infantile idiopathic thrombocytopenic purpura

Comparison of idiopathic thrombocytopenic purpura in children between 3 months and 2 years versus 2-5 years

It has been reported that infantile idiopathic thrombocytopenic purpura (ITP) has different clinical features than ITP seen in older ages and classification of bleeding sites and grading of bleeding severity can be used in determining the risk of bleeding. In this study, patients with ITP were divided into two groups according to age (<2 years and 2-5 years). The clinical features, laboratory findings, treatment modalities, rate of response and chronicity, bleeding sites, grades of bleeding were compared between each group. No significant differences were established.

Acute immune thrombocytopenic purpura in infants: associated factors, clinical features, treatment and long-term outcome

The natural course of acute immune thrombocytopenic purpura (ITP) in infants is poorly described in the literature. A retrospective study of 17 consecutive patients <1 yr of age admitted and treated for acute ITP between 1996 and 2005 was conducted. We investigated their demographics, vaccination history, clinical features, laboratory examinations, response to treatment and long-term outcome. There were 11 male and six female infants. Their ages ranged from 24 d to 12 months with a median of 3 months. All infants presented with petechiae and/or ecchymoses. Fourteen cases had platelet counts below 20 x 10(9)/L at the time of admission. They all had good response to a single course of treatment (14/17) or multiple courses of treatment (3/17). None had progressed into chronic ITP. Seven infants had a causal relationship with immunization, five associated with hepatitis B, one diphtheria-pertussis-tetanus, one diphtheria-tetanus-acellular pertussis-inactivated poliovirus vaccine-conjugated Haemophilus influenza vaccines. These seven infants responded to treatment within 3-9 d after therapy with intravenous immunoglobulin, high-dose methylprednisolone or oral steroids. Re-boosters with vaccines revealed no recurrence of the disease in all of these seven patients. The study suggests that further immunization is not contraindicated in infants experiencing acute ITP associated with vaccines.

Clinical features and treatment outcomes of 79 infants with immune thrombocytopenic purpura

BACKGROUND

To determine the clinical features and treatment outcomes of infants with immune thrombocytopenic purpura (ITP).

METHODS

Retrospective analysis of 79 infant ITP patients treated from 1987 to 2002. The data abstracted comprised age, gender, clinical features, and treatment outcomes. A score test for the trend in the odds ratios was used to determine the risk of chronic ITP with advancing age. The infants were compared to a group of contemporaneous older children with regard to bleeding severity and incidence of chronic ITP.

RESULTS

The 34 female and 45 male infants had a median age of 16 months. Seventy-four presented with purpura, four with viral illnesses, and one was asymptomatic. Eight percent had active mucosal bleeding. The median platelet count was 8,000/microl. Forty infants received intravenous immunoglobulin, nine intravenous anti-D immunoglobulin, six steroids, and seven were observed without treatment. Fifty-five (76%) responded to a single course of treatment. Only 9% of infants developed chronic ITP compared to 18% of children between the ages of 25 and 119 months and 47% of children 120 months or older (P<0.0005).

CONCLUSIONS

Infants with ITP respond favorably to treatment and are less likely to develop chronic ITP compared to older children.

Oral megadose methylprednisolone versus intravenous immunoglobulin for acute childhood idiopathic thrombocytopenic purpura

Twenty children with acute idiopathic thrombocytopenic purpura (ITP) were randomized to receive either oral megadose methylprednisolone (MDMP) or intravenous immunoglobulin G (IV IgG). Normal platelet counts (> or = 150 x 10(9)/l) were obtained in 6 patients of each group in 3 days and in 8 and 9 patients treated with oral MDMP and with IV IgG within 1 week, respectively. It is concluded that oral MDMP could easily be used for the early elevation of platelet counts, which is important for ITP treatment.