CHRONIC CHILDHOOD IDIOPATHIC THROMBOCYTOPENIA PURPURA - LONG-TERM FOLLOW-UP

An understanding of the natural history of childhood chronic idiopathi c thrombocytopenia purpura (ITP) could contribute to a rational therap eutic approach to its treatment, which remains controversial. In our r etrospective study of 92 children with ITP, 22 had a chronic course an d were followed for 3-14 years (median 8.6 years). Treatment, when ind icated, was individualized: 4 patients (18.2%) did not receive any tre atment, 14 (63.6%) received steroids only, while 4 (18.2%) were treate d with steroids and one of the following: high-dose gamma globulin (4 patients), splenectomy (2 patients) or immunosuppressive therapy (2 pa tients). During follow-up, 14 patients (63.6%) achieved complete remis sion, 5 (22.7%) partial remission and only 3 (13.5%) remained severely thrombocytopenic, with minimal bleeding tendency. Eleven patients (50 %) responded to the initial prednisone course (1-5 mg/kg/day), but sho wed a marked decrease in platelet count when steroids were tapered off . In view of the high rates of complete and partial remission and the mild course of the few non-responding patients, it is suggested that w ith adequate supportive therapy, follow-up problems and fatalities can be kept to a minimum. We believe that aggressive therapy, such as spl enectomy, should be reserved for the rare symptomatic and severely thr ombocytopenic patient.