Jhingan Akshat, Goel Neha, Singh Amitabh, Gera Rani, Chopra Nidhi, Mehndiratta Sumit, Sharma Monica
Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi 110029, India.
Department of Hematology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi 110029, India.
J Hematol. 2025 Jun;14(3):133-138. doi: 10.14740/jh2052. Epub 2025 May 13.
Standard management of acute immune thrombocytopenic purpura (ITP) remains debated, with some advocating observation for mild cases, while others recommend pharmacological intervention to accelerate platelet recovery in children with severe thrombocytopenia (TCP) (platelet count < 20,000/mm) or significant mucosal bleeds. Corticosteroids, particularly prednisolone (PDN), are a widely used first-line treatment due to their rapid immunosuppressive effect. This prospective cohort study evaluated the effectiveness of short-course high-dose PDN (4 mg/kg/day for 7 days) in treating children aged 1 - 12 years with newly diagnosed acute ITP. The study aimed to assess the clinical and hematological profile of these children and the mean time to platelet recovery.
A total of 61 patients were enrolled, and their response to treatment was monitored at various intervals, including 48 h, 72 h, day 7, 1 month, and 3 months.
Results revealed a rapid platelet recovery in patients receiving high-dose PDN, with 83.6% of patients achieving platelet counts greater than 50,000/mm by day 7. Additionally, 91.8% maintained platelet recovery at 1 month. The study also found that the age group 6 - 12 years had a higher risk of persistent ITP (24.5%), highlighting the importance of close monitoring in this demographic. While the treatment was generally well tolerated, some mild side effects like hypertension and glycosuria were observed.
The study suggests that short-course high-dose PDN can be an effective first-line therapy for acute ITP. It promotes faster platelet recovery and reduces hospitalization time with minimal adverse effects.
急性免疫性血小板减少性紫癜（ITP）的标准治疗方案仍存在争议，一些人主张对轻症病例进行观察，而另一些人则建议对严重血小板减少症（TCP）（血小板计数<20,000/mm³）或有明显黏膜出血的儿童进行药物干预以加速血小板恢复。皮质类固醇，尤其是泼尼松龙（PDN），因其快速的免疫抑制作用而被广泛用作一线治疗药物。这项前瞻性队列研究评估了短疗程高剂量PDN（4mg/kg/天，共7天）治疗1至12岁新诊断急性ITP儿童的有效性。该研究旨在评估这些儿童的临床和血液学特征以及血小板恢复的平均时间。
共纳入61例患者，并在不同时间间隔（包括48小时、72小时、第7天、1个月和3个月）监测他们对治疗的反应。
结果显示，接受高剂量PDN治疗的患者血小板迅速恢复，83.6%的患者在第7天时血小板计数大于50,000/mm³。此外，91.8%的患者在1个月时维持血小板恢复。研究还发现，6至12岁年龄组持续性ITP的风险较高（24.5%），突出了对此人群密切监测的重要性。虽然该治疗总体耐受性良好，但观察到一些轻微副作用，如高血压和糖尿。
该研究表明，短疗程高剂量PDN可作为急性ITP的有效一线治疗方法。它能促进更快的血小板恢复，减少住院时间，且副作用最小。
