Koçak Ulker, Aral Yusuf Ziya, Kaya Zühre, Oztürk Gülyüz, Gürsel Türkiz
Department of Pediatric Hematology, Gazi University Faculty of Medicine, Ankara, Turkey.
Turk J Pediatr. 2007 Jul-Sep;49(3):250-5.
Diagnostic evaluation and management in childhood immune thrombocytopenic purpura (ITP) are controversial. We reviewed the files of 162 children with ITP to evaluate clinical characteristics, response to treatment and outcome. History of antecedent infection, vaccination and serologic evidence for acute viral infection were present in 48%, 5% and 17% of the patients, respectively. At diagnosis, two-thirds of the patients had a platelet count of <10,000/microl but only 10% had major bleedings. Intracranial hemorrhage was seen in two patients (1.2%) with a mortality rate of 0.6%. Sixteen percent developed chronic ITP. The rate of platelet recovery with mega-dose methylprednisolone (30 mg/kg/d for 3 and 20 mg/kg/d for 4 days) was similar to that obtained with intravenous immunoglobulin or oral prednisolone. Four of seven patients with ITP responded to splenectomy. These data show that mode of treatment has no effect on the clinical course and prognosis of childhood ITP.
儿童免疫性血小板减少性紫癜（ITP）的诊断评估与治疗存在争议。我们回顾了162例ITP患儿的病历，以评估其临床特征、治疗反应及预后。分别有48%、5%和17%的患者有前驱感染史、疫苗接种史及急性病毒感染的血清学证据。诊断时，三分之二的患者血小板计数<10,000/微升，但只有10%的患者有严重出血。两名患者（1.2%）发生颅内出血，死亡率为0.6%。16%的患者发展为慢性ITP。大剂量甲泼尼龙（30 mg/kg/d，连用3天，20 mg/kg/d，连用4天）的血小板恢复率与静脉注射免疫球蛋白或口服泼尼松龙相似。7例ITP患者中有4例对脾切除术有反应。这些数据表明，治疗方式对儿童ITP的临床病程和预后没有影响。
