Bolton-Maggs P H, Moon I
Department of Haematology, Alder Hey Children's Hospital, Liverpool, UK.
Lancet. 1997 Aug 30;350(9078):620-3. doi: 10.1016/s0140-6736(97)04143-3.
Guidelines for management of acute immune thrombocytopenic purpura (ITP) in childhood were published in 1992. Regional audit in 1995 showed substantial variation in clinical practice not related to clinical differences in patient groups, which indicated a need for national audit.
Individuals aged from birth to their 16th birthday newly presenting with ITP were identified over 14 months by regular mailing of paediatricians and haematologists for case notification. Information was obtained from follow-up by a detailed questionnaire.
ITP was clinically mild and benign in 323 (76%) of 427 cases, including 181 (70%) of 260 cases with platelet counts below 10 x 10(9)/L. There were no deaths or intracranial haemorrhages. There was a substantial discrepancy between clinical practice and published guidelines: many children were admitted to hospital and received treatment unnecessarily; there was overuse of intravenous immunoglobulin (IVIg) as first-line therapy (94 children); children received steroids without marrow examination; and there was inappropriate use of platelet transfusions (41 with mild or moderate disease).
Our results indicate a need for change in practice.
1992年发布了儿童急性免疫性血小板减少性紫癜（ITP）的管理指南。1995年的地区审计显示，临床实践存在很大差异，且与患者群体的临床差异无关，这表明需要进行全国性审计。
通过定期向儿科医生和血液科医生邮寄病例通知，在14个月内确定了年龄从出生到16岁新诊断为ITP的个体。通过详细问卷从随访中获取信息。
427例病例中有323例（76%）临床症状轻微且为良性，其中血小板计数低于10×10⁹/L的260例中有181例（70%）。无死亡或颅内出血病例。临床实践与已发布的指南之间存在很大差异：许多儿童不必要地住院并接受治疗；过度使用静脉注射免疫球蛋白（IVIg）作为一线治疗（94例）；儿童未进行骨髓检查就接受了类固醇治疗；并且不恰当地使用了血小板输注（41例轻度或中度疾病患者）。
我们的结果表明实践需要改变。
