Idiopathic thrombocytopenic purpura (ITP) in children

Idiopathic thrombocytopenic purpura in children remits spontaneously in the majority of cases but most children require treatment. Between 1995 and 2005, 265 children (0-15 years old) have been consecutively observed and treated: 28 children with high doses of methylprednisolone (HDMP) (15 mg/k × 4 days), 63 with HDMP (7.5 mg/kg × 4 days), 37 with HD dexamethasone (DXM) pulses, 29 with low doses of MP, and 51 with different doses of intravenous immunoglobulins (IVIG) (0.4 or 0.8 g/kg). Fifty-seven children have not been treated because of a platelet count ≥10 × 10⁹/L and no significant bleeding. Two hundred forty-four (92.1%) children reached a persistent CR, 237 (89.4%) after a first-line treatment or the wait and see strategy. No statistically significant differences in CR related to different treatments have been observed. IVIC and HDMP (7.5 mg/kg for 4 days) are the best treatments to reach quickly safe platelet levels ≥30 × 10 ⁹/L (3-6 days) and CR (7-11 days). Among non-responding (NR) patients, seven, have been splenectomized and three reached, stable CR. These results emphasize differences with adult ITP.