We have reviewed medical records of 1014 children with idiopathic thrombocytopenic purpura (ITP), who were seen at our departments during the past 10 yrs. Initial work-up included CBC, platelet and reticulocyte counts, direct Coombs' test, ANA, quantitation of serum immunoglobulins, bone marrow aspiration and anti-platelet antibody, when available. One hundred are forty nine patients were excluded because of inadequate follow-up. Of the remaining 875 patients, 33% had acute and 67% chronic ITP (thrombocytopenia longer than 6 mths). Ninety five patients were under 15 mths old (38 days to 15 mths). This latter group received IVIgG as first line therapy and steroids, if refractory to IVIgG. According to our policy all patients with platelet counts< 20,000 and active bleeding received IVIgG and less severe cases prednisolone. High dose dexamethasone and methlyprednisolone were next in line as was danazol, which was applied as a 3-mths course to pts older than 10 yrs. Two hundred and twenty one pts did not receive any treatment, 50 pts were only administered IVIgG and 301 pts were only given prednisolone, 187 pts received both IVIgG and prednisolone. Eleven pts underwent splenectomy. One pt died of CNS hemorrhage. Cytoxic drugs were used only in 2 pts.
Results: Chronic ITP has been prevalent among our afflicted children. There has been good response to IVIgG in combination with prednisolone and splenectomy could be avoided or postponed in most of the pts. The response to either high dose dexamethasone or methylprodnisolone in non-splenectomized pts has been only temporary.
