Marks M K, Vadamalayan B, Ekert H, South M J
Royal Children's Hospital, Melbourne, Victoria, Australia.
J Paediatr Child Health. 2005 Jan-Feb;41(1-2):52-5. doi: 10.1111/j.1440-1754.2005.00536.x.
In Australia acute idiopathic thrombocytopenic purpura (ITP) is mainly treated by paediatricians (either general paediatricians or paediatric haematologists/oncologists). A survey was conducted to gauge the current practice of treating children with acute ITP in Australia.
All practising Australian paediatricians registered by the Royal Australasian College of Physicians were surveyed regarding their intended management of children with acute ITP. The questionnaire, adapted from a study of paediatric haematologists/oncologists in North America, presented four clinical scenarios of children with acute ITP with a platelet count of 3000 x 10(9)/L, with and without mucosal bleeding (wet and dry purpura, respectively). Questionnaires were returned by mail or filled in online at a dedicated webpage.
Five hundred and sixty-three of 1097 (51%) paediatricians responded to the survey. Data from 140 who had treated at least one child with ITP in the previous 12 months were analysed. Respondents indicated that children with acute ITP are usually or always hospitalised (58-92%) and that 48% would be given active treatment, even with dry purpura. Various regimens of i.v. immunoglobulin or corticosteroids are used when treatment is administered. In comparing Australian and North American management of acute ITP there were many similarities, although Australian paediatricians were less likely to arrange a bone marrow aspirate if corticosteroids were prescribed.
There is great variation in the intended management of children with acute ITP in Australia. Previously published management recommendations regarding investigation and treatment have had little impact on intended practice. Prospective studies are required to evaluate hypotheses so as to produce evidence-based recommendations for treatment of patients with acute ITP.
在澳大利亚，急性特发性血小板减少性紫癜（ITP）主要由儿科医生（普通儿科医生或儿科血液科/肿瘤科医生）进行治疗。开展了一项调查，以评估澳大利亚目前治疗儿童急性ITP的做法。
对所有在澳大利亚皇家内科医师学院注册的执业儿科医生进行调查，了解他们对儿童急性ITP的预期治疗方法。该问卷改编自一项针对北美的儿科血液科/肿瘤科医生的研究，呈现了4种急性ITP儿童的临床病例，血小板计数为3000×10⁹/L，有或无黏膜出血（分别为湿性和干性紫癜）。问卷通过邮寄方式返回，或在专门的网页上在线填写。
1097名儿科医生中有563名（51%）回复了调查。对过去12个月内至少治疗过1例ITP患儿的140名医生的数据进行了分析。受访者表示，急性ITP患儿通常或总是住院治疗（58 - 92%），48%的医生即使患儿为干性紫癜也会给予积极治疗。治疗时会使用各种静脉注射免疫球蛋白或皮质类固醇方案。在比较澳大利亚和北美对急性ITP的治疗方法时，发现有许多相似之处，不过如果开具了皮质类固醇药物，澳大利亚的儿科医生安排骨髓穿刺的可能性较小。
澳大利亚对儿童急性ITP的预期治疗方法存在很大差异。先前发表的关于检查和治疗的管理建议对预期实践影响不大。需要进行前瞻性研究来评估各种假设，以便为急性ITP患者的治疗提出基于证据的建议。
