Περίληψη:
Between 1975 and 1992 450 children with idiopathic thrombocytopenic
purpura (ITP) were diagnosed, and of those 100 (22%) developed the
chronic form of the disease. Approximately half the patients with
chronic ITP presented with mild to moderate hemorrhagic manifestations
at the onset of purpura (30 cases) and/or later during the course of the
disease (25 cases). The incidence of intracranial hemorrhage was 1%,
and the mortality rate due to overwhelming septicemia after splenectomy
was also 1%. Overall one-third of the patients received no therapy;
two-thirds of them went into spontaneous remission within 8 months to 8
years from the onset of ITP. Steroids given in conventional or high
doses (51 cases) achieved a transient (if any) rise in platelet count,
but in no case were steriods curative. Remission related to intravenous
immune globulin (IVIG) therapy was noticed in 38.5% of the children (10
of 26) after variable courses. The response rate to splenectomy was
95.0%. Ultimately the long-term outcome in children with chronic ITP
was as follows: remission, 58 cases (spontaneous, 30; after IVIG
therapy, 10; after splenectomy, 18); hemostatic platelet values, 22
cases (spontaneous, 16; after IVIG, 5; after splenectomy, 1). Thirteen
children were lost in follow-up, and 7 remain thrombocytopenic but
asymptomatic. These data indicate that chronic ITP in childhood runs a
benign course in most cases and may remit with or without therapy even
several years from onset. Therefore, therapeutic intervention has to be
individualized, and splenectomy, which is not always safe, should be
reserved for problematic cases that fail to respond to conventional
therapeutic modalities.
Συγγραφείς:
ARONIS, S
PLATOKOUKI, H
MITSIKA, A
HAIDAS, S and
CONSTANTOPOULOS, A
