A comparative study of initial use of intravenous immunoglobulin and prednisolone treatments in childhood idiopathic thrombocytopenic purpur.

BACKGROUND: Idiopathic thrombocytopenic purpura (ITP) is an acquired disorder characterized by immune-mediated platelet destruction. The aims of this study were to compare initial platelet count elevation and to determine the chance of developing persistent profound thrombocytopenia by intravenous immunoglobulin (IVIG) or prednisolone in the treatment of children with ITP.

METHODS: Eighty-seven children, aged from 3 months to 14 years old, diagnosed with ITP and initial platelet count less than 20 x 10(3)/mm3 were divided into two groups. Fifty-four patients received IVIG (1 g/kg/dose) for two days. Then, they received prednisolone treatment at a dose of 1 mg/kg/d starting on day 8 to maintain platelet count, followed by a tapering dose until day 60. Thirty-three patients received prednisolone (2 mg/kg/day) for 14-21 days, followed by a tapering dose until day 60. Platelet counts were evaluated on presentation days 2, 3, 5, 7, 30, 60, 90, 120, 150 and 180.

RESULTS: Forty-four of 54 patients (81.5%) treated with IVIG demonstrated a rapid increase in platelet count above 20 x 10(3)/mm3 on the second day, compared to 13 of 33 patients (39.4%) in the group treated with prednisolone initially (p<0.01). There were no significant differences in mean platelet counts between both groups on days 3, 5, 7 or 30, 60, 90, 120, and 180 (all p>0.05). No serious bleeding, such as ICH, was noted in either treatment group. Persistent platelet counts lower than 20 x 10(3)/mm3 after 6 months of follow-up developed in 18 patients (33.3%) in the IVIG group and in 10 patients (30.3%) in the prednisolone group (p=0.480).

CONCLUSIONS: In our study, patients treated with IVIG demonstrated a higher percentage of patients with platelet count increasing above 20 x 10(3)/mm3 on the second day compared with patients treated with prednisolone initially (p<0.01). However, there was no difference in developing persistent platelet counts lower than 20 x 10(3)/mm3 at 6 months of follow-up between the IVIG and prednisolone groups (p=0.480).