OBJECTIVE

To analyze the efficacy of the clinical guidelines (ID699) for immune thrombocytopenia (ITP).

MATERIAL AND METHODS

We analyzed 13 patients (girls-46%, boys-54%, mean age 9.5 (range 4—17) years) with ITP admitted to the Tver Children’s Regional Clinical Hospital in 2023. Previous infection was noted in 69%, measles vaccination was performed in 8%. Mean period after onset of infection was 11 (5—15) days. Bleeding grades 1—3 were observed in 4 (31%), 3 (23%) and 6 (46%) patients, respectively. Hematuria was observed in 3 (23%) cases, menorrhagia in 1 (8%) case. Mean platelet count at admission was 17 (1.0—86)·10⁹/l.

RESULTS

Annual morbidity was 5.7 per 100.000 children. Dexamethasone 20 mg/m² for 1—3 days was used in 54% of cases, intravenous immunoglobulin (IVIG) 1000 mg/kg/day — in 15%, prednisolone 2 mg/kg for 21 days — in 8%. Follow-up was organized in 23% of cases. In 2 (17%) cases, discontinuation of steroid therapy with subsequent IVIG was necessary due to hemorrhagic syndrome deterioration or/and complication of steroid therapy. Partial and complete responses were achieved in 8 (62%) and 4 (31%) cases, respectively. We could not evaluate response in 1 (8%) case. Overall efficacy of first-line therapy was 92%. Mean platelet count at discharge was 107 (20—307)·10⁹/L, hospital-stay — 10.2 (2—23) days. Platelet count decrease to grade 1—2 was observed in 23% within 6 weeks with spontaneous complete recovery throughout the next 1—2 weeks. Mean follow-up was 153 (48—261) days.

CONCLUSION

Treatment in accordance with the ID699 clinical guidelines is effective regarding primary response and prevention of recurrent ITP in children regardless of therapeutic approach.