[Differences in the treatment of idiopathic thrombocytopenic purpura in children]

Idiopathic thrombocytopenic purpura (ITP) is a rare immune-mediated bleeding disorder that usually takes a self-limiting and benign course. Due to the risk of intracranial haemorrhage, treatment regimens tend to be active. We present treatment data from 17 paediatric departments in Denmark (1998-2000), focusing on regional differences in treatment strategy.

As part of a prospective Nordic study, clinical findings and treatment were recorded for 109 children with newly diagnosed ITP. The course in the following six months was reported for 91 children. Results are compared for three geographical regions: East, North and South.

Pharmacotherapy, almost exclusively intravenous immunoglobulin, was given within 14 days of diagnosis to 89%, 70%, and 48% in regions East, North, and South, respectively. A very low platelet count was the main indication. Platelet transfusion was given to 24%, 0% and 4%, respectively. There were no differences in remission rates or frequency of mucosal bleeding during follow-up, but treatment rates were 6.3, 4.7, and 3.0 per patient-year with severe thrombocytopenia. Chronic ITP lasting more than six months developed in 26%, 33%, and 18%, respectively.

We found obvious regional differences in treatment strategy which reflect differences in international clinical guidelines. The initial treatment approach had no influence on morbidity, time of remission or risk of chronic course.