Agha Shabbir Ali, Farhana Ahmad, Sadia Saeed, Azhar Abbas, Adeela Chaudhary.
Idiopathic thrombocytopenic purpura – initial illness and subsequent behaviour.
Pak Paed J Jan ;29(2):93-9.

Aims of this study were to find frequency, to compare the various characteristics associated with two forms of immune thrombocytopenia, and to evaluate the response to various treatment modalities in a referral centre. Methods: 58 children diagnosed as having ITP during years 2003 and 2004 in the hematology/ oncology department of Children`s Hospital/The Institute of Child Health, Lahore were enrolled in this observational descriptive study. Results: ITP constituted 3.4% of total admitted cases in this department, 31% being chronic ITP cases. Comparing acute and chronic cases, higher mean age (8.6 years vs. 5.6 years), female sex (M: F- 1:2 vs. 1:1), lower platelet count (>20,000 vs. <20,000/cumm) and longer duration of symptoms at presentation (mean of 12 vs. 4 days) supported ultimate chronic outcome. 17.5% acute ITP cases were treated with only supportive measures, prednisolone 50%, methyl prednisolone pulses 7.5%, IVIG 25%, 80% responded to above treatment. In chronic ITP, only supportive treatment 16.5%, prednisolone 55.5%, methyl prednisolone pulses 11.1%, IVIG 5.5%, anti-D immunoglobulin 22.2%, danazol 22.5% and splenectomy 16.6%, were tried showing response in 33% cases out of which 22% relapsed. All patients responded to splenectomy with two episodes of serious sepsis in one case. Intracranial hemorrhage (ICH) was seen in 2 cases of chronic ITP (3.4% of total cases). Conclusion: ITP is an important cause of hospital admissions. Despite increase incidence of infection, splenectomy could be considered as a treatment option in these cases.

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