Use of Intravenous Methylprednisolone in Acute Idiopathic Thrombocytopenic Purpura

Jayabose, Somasundaram; Patel, Padma; Inamdar, Sarla; Brilliant, Renee; Mamtani, Ravinder

doi:10.1097/00043426-198722000-00003

Cited by 16 publications

(3 citation statements)

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“…The average weight gain in children was only 1.7%. Similar results were reported by Jayabose et al, 29 who treated 20 children with acute ITP with IV methylprednisolone 5 mg/kg/day given in four divided doses until the platelet count increased to 50 ϫ 10 9 /L. By 48 hours from the start of therapy, 90% of treated children had platelet counts > 20 ϫ 10 9 /L, and all children had achieved this hemostatic threshold by 72 hours from the time of initial diagnosis.…”

Section: Corticosteroidssupporting

confidence: 86%

Childhood Acute Immune Thrombocytopenic Purpura: 20 Years Later

Blanchette

Carção²

2003

Semin Thromb Hemost

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Childhood acute immune thrombocytopenic purpura (ITP) is a typically benign, self-limiting illness usually occurring after an infectious disease. Most affected children have platelet counts < 20 x 10 (9)/L at presentation and are at small, but definite risk for an intracranial hemorrhage. This feared complication occurs in < 1% of all children with acute ITP. There is consensus that a bone marrow aspirate should be performed in children with acute ITP and atypical features (e.g., hepatosplenomegaly), and most physicians continue to recommend this investigation before corticosteroids are administered. Issues such as hospitalization versus observation at home, and treatment versus no treatment continue to be debated; there is consensus, however, that children with extreme thrombocytopenia (platelet counts < 10 x 10 (9)/L) and/or clinically significant hemorrhage merit treatment with a regimen known to rapidly increase the circulating platelet count. Candidate regimens include high-dose intravenous (IV)/oral corticosteroids (>/= 4 mg/kg/day of prednisone or an equivalent corticosteroid preparation), IV immunoglobulin (IG; 0.8 to 1.0 g/kg once) or IV anti-D (75 microg/kg once) for Rhesus-positive patients. For those rare children with organ- or life-threatening hemorrhage (e.g., intracranial hemorrhage) multimodality therapy including platelet transfusion, IV high-dose methylprednisone (30 mg/kg, maximum 1 g) and IVIG (1 g/kg) is indicated with consideration of emergency splenectomy. Future prospective trials should include outcome measures other than the platelet count alone (e.g., bleeding scores) and health-related quality-of-life assessments. Key questions that remain to be addressed in children with acute ITP include the need for bone marrow aspiration in typical cases if corticosteroid therapy is planned, the role of hospitalization, and most important, the unresolved issue of treatment versus no treatment, especially in patients with typical features and mild clinical bleeding symptoms.

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Section: Corticosteroidssupporting

confidence: 86%

Childhood Acute Immune Thrombocytopenic Purpura: 20 Years Later

Blanchette

Carção²

2003

Semin Thromb Hemost

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“…Higher dose steroids given for a short period have recently been shown to be effective at raising the platelet count within 2 to 4 days. [34][35][36] The dose of corticosteroids given varied across the studies and ranged between 4 mg/kg per day to 30 mg/kg per day of prednisone or methylprednisolone for up to 4 days. There were no undue side effects noted when a dose of 4 mg/kg per day for 4 days orally was used.…”

Section: Corticosteroidsmentioning

confidence: 99%

Acute Idiopathic Thrombocytopenic Purpura of Childhood-Diagnosis and Therapy

Brousseau¹

2005

Pediatric Emergency Care

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This CME activity is intended for physicians, nurse practitioners, and physician assistants who care for children who are ill or injured. Specialists including pediatricians, emergency physicians, pediatric emergency physicians, and family practitioners will find this information particularly useful. LEARNING OBJECTIVESAfter completion of this article, the reader will be able to: 1. Describe the pathophysiology of idiopathic thrombocytopenic purpura. 2. Recognize common bleeding manifestations of acute idiopathic thrombocytopenic purpura and learn the clinical grading scale used to estimate the severity of bleeding manifestations. 3. Discuss the management of acute idiopathic thrombocytopenic purpura and understand treatment strategies for life-threatening bleeding.I diopathic thrombocytopenic purpura (ITP) is an immunemediated illness that results in thrombocytopenia (platelet count <150 Â 10 9 /L) due to platelet destruction from autoantibodies. It is classified as acute or chronic in children depending on the duration of the illness. Acute ITP occurs most commonly in children between the ages of 1 and 10 years and resolves in less than 6 months. Chronic ITP, by definition, lasts longer than 6 months and more commonly occurs in children older than 9 years. Two recent studies reported that approximately half of children aged 10 to 18 years with acute ITP developed chronic ITP. 1,2 Overall, 75% of patients with acute ITP will have resolution of their thrombocytopenia with or without treatment 6 months after diagnosis.The presentation and management of a child with acute ITP are varied and dependent upon many factors, such as the age of the child and clinical symptoms at presentation. This review focuses on the diagnosis and management of acute ITP of childhood. EPIDEMIOLOGY AND PATHOPHYSIOLOGYThe annual incidence of acute ITP is estimated to be 2.5 to 5 per 100,000 children. 3,4 The peak age for presentation is 5.5 years. 3,5 There are some data supporting seasonal changes with a peak occurrence in the spring or early summer. 3,5 This seasonal variation may be linked to occurrence of viral illnesses during the same period. A history of a preceding viral illness is commonly associated with the development of acute ITP. The thrombocytopenia noted at presentation is severe, defined as a platelet count less than 20 Â 10 9 /L in more than 75% of patients. [3][4][5] The cause of ITP is unknown. Up to 50% to 80% of children with ITP will have antiplatelet antibodies that react with major membrane glycoproteins. 6 These antibodies are produced by B cell-derived plasma cells. Most of these antibodies are of the immunoglobulin (Ig) G class and are directed against glycoprotein IIb/IIIa and/or Ib/IX. 6-10 Platelet antibody complexes are cleared more rapidly by macrophages from the spleen and liver, resulting in thrombocytopenia. It remains to be elucidated what other critical factors play a role in the development of acute ITP such as the contribution of T-cell dysregulation and why some children go on to develop chronic au...

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“…Intravenous methylprednisolone (5 mg/kg/d) in four divided doses had been used previously in 20 children with severe acute ITP by Jayabose et a1 (14) in order to increase platelet counts to over 5OOOO/pl in 5 d. 10 adult patients with ITP were also treated with intravenous methylprednisolone 434 OZSOYLU ET AL (loo0 mg) with early response (15). It is likely that oral prednisone would be equally effective at comparable doses (16).…”

Section: Discussionmentioning

confidence: 99%

High‐dose intravenous methylprednisolone for acute childhood idiopathic thrombocytopenic purpura

Özsoylu

İrken

Karabent

1989

European J of Haematology

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49 children with acute idiopathic thrombocytopenic purpura (ITP) were divided into non-treatment, oral prednisone (2 mg/kg), and high-dose intravenous methylprednisolone (HIVMP) treatment groups which consisted of 17, 16 and 16 children respectively. Platelet counts rose above 150000/~1 over a 2-week period in 5 (29.4%) children in the first group, 5 (31.2%) in the second group and 15 (93.7%) children in the third group. Platelet counts reached the normal level in only 3 days in 11 (68.7%) children treated with HIVMP. Initially, antiplatelet antibodies (APA) were shown by the Handin and Stossel method in every patient. With normalization of platelet counts, the antibodies decreased but could still be detected in every case; antibody decrease was greater in the HIVMP group. With the exception of mild cushingoid appearance, none of the major corticosteroid side effects was observed in the treated children.

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Use of Intravenous Methylprednisolone in Acute Idiopathic Thrombocytopenic Purpura

Cited by 16 publications

References 0 publications

Childhood Acute Immune Thrombocytopenic Purpura: 20 Years Later

Childhood Acute Immune Thrombocytopenic Purpura: 20 Years Later

Acute Idiopathic Thrombocytopenic Purpura of Childhood-Diagnosis and Therapy

High‐dose intravenous methylprednisolone for acute childhood idiopathic thrombocytopenic purpura

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