Первичная иммунная тромбоцитопения у детей: анализ эффективности лечения в соответствии с Национальными клиническими рекомендациями

Abstract

AIM. To assess the treatment efficacy in children with primary immune thrombocytopenia (ITP). MATERIALS & METHODS. The analysis included 13 ITP patients (6 girls and 7 boys) with the mean age of 9.5 years (range 4–17 years) admitted to the Pediatric Hospital of the Tver region in 2023. Primary ITP was preceded by infection in 9 (69 %) children and by measles vaccination in 1 (8 %) child. The mean time after infection onset was 11 days (range 5–15 days). As assessed by the pediatric bleeding score, hemorrhage severity was of grade 1 in 4 (31 %), grade 2 in 3 (23 %), and grade 3 in 6 (46 %) patients. Hematuria was identified in 3 (23 %) patients, and menorrhagia was detected in 1 (8 %) patient. The mean platelet count by the time of admission to the hospital was 9 × 109/L (range 1–86 × 109/L). RESULTS. The incidence of newly diagnosed primary ITP appeared to be 5.7 cases per 100,000 children in the Tver region. Treatment started with 20 mg/m2 IV dexamethasone on Day 1–3 in 7 (54 %) children, 1000 mg/kg IVIG on Day 1 in 2 (15 %) children, and 2 mg/kg prednisolone per os during 21 days in 1 (8 %) child. Dynamic follow-up was conducted on 3 (23 %) patients. In 2 (17 %) patients, steroid therapy had to be discontinued and IVIG was started due to increased hemorrhage and/or developing corticosteroid complications. Partial and complete responses were achieved in 8 (62 %) and 4 (31 %) patients, respectively. In 1 (8 %) case, the response was not assessed. The overall response rate to the first-line therapy was 92 %. The mean platelet count at hospital discharge was 107 × 109/L (range 20–307 × 109/L), and the mean number of hospital days was 10.2 (range 2–23). The platelet count decrease to grade 1/2 was observed in 3 (23 %) children during the first 6 weeks followed by spontaneous complete recovery during the subsequent 1–2 weeks. CONCLUSION. The treatment of pediatric primary ITP in full compliance with the National Clinical Guidelines showed very high efficacy in terms of achieving primary response and preventing relapses. The relatively high overall IVIG use rate was accounted for by a slow response to corticosteroids, increased hemorrhage, risk factors, and parental concern.