Volume 6, Issue 3 (9-2016)                   Iran J Ped Hematol Oncol 2016, 6(3): 149-156 | Back to browse issues page

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Farhangi H, Badiei Z, Ghasemi A, Hesari S, Banihashem A. Comparison of Anti-D Immunoglobulin and Dexamethasone in Chronic and Persistent Forms of Pediatric Immune Thrombocytopenic Purpura. Iran J Ped Hematol Oncol 2016; 6 (3) :149-156
URL: http://ijpho.ssu.ac.ir/article-1-263-en.html
Comparison of Anti-D Immunoglobulin and Dexamethasone in Chronic and Persistent Forms of Pediatric Immune Thrombocytopenic Purpura
Hamid Farhangi , Zahra Badiei , Ali Ghasemi , Sara Hesari , Abdollah Banihashem *
. Associate Professor of Pediatric Hematology & Oncology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
Abstract:   (6113 Views)

Bakcground: The aim of ITP treatment is to prevent intracranial hemorrhage and increase the platelet count rapidly. This study was conducted with the objective of comparing the efficacy of anti-D immunoglobulin (Ig) with dexamethasone in treating childhood ITP.

Materials and Methods: In this randomized prospective control trial, 20 ITP patients (Platelet count<20,000/µl) younger than 16 were selected from those who referred to Dr. Sheikh Children Training and Research Hospital in Mashhad, Iran From February 2013 to January 2014. Patients were divided into two groups according to the type of administered treatment: group A received intravenous dexamethasone 40 mg/m2/ daily for four days. Group B received a single dose of intravenous anti-D Ig 50 µg/kg. The resultant data were then evaluated using SPSS (version 11.5).

Results: In this study, 20 patients [11 girls (55%) and 9 boys (45%)] with the mean age of 5.6±4 years were enrolled. From the total number, 13 (65%) were younger than 5 years old, 4 (20%) aged between 5 and 10, and 3 (15%) were older than 10. There was no significant difference between the two groups regarding sex and age. In both groups the most common symptom was cutaneous manifestations (purpura, ecchymoses) (63.6% vs. 36.4% p=0.325). At enrolment time, the mean disease duration was 28±21 months, ranging from 5 to 132 months. Out of 20 patients, 9 (45%) suffered from chronic ITP, and 11 (55%) were in persistent phase of the disease. No significant difference was observed between the two groups regarding the frequency of chronic and persistent cases (p=0.370). Similarly, the follow-up platelet count four months after the treatment showed no significant difference between the two groups (p=0.241).

Conclusion: The findings of this study did not confirm the priority of dexamethasone over anti-D Ig. The hemolytic side effects of anti-D were negligible compared to dexamethasone.

Keywords: Dexamethasone, Idiopathic, Purpura, RHO(D) antibody, Thrombocytopenic
Full-Text [PDF 166 kb]   (1081 Downloads)    
Type of Study: Research | Subject: Heart
Received: 2014/11/25 | Accepted: 2015/12/5 | Published: 2017/02/23
References
1. Hachisuga K, Hidaka N, Fujita Y, Fukushima K, Kato K. Can we predict neonatal thrombocytopenia in offspring of women with idiopathic thrombocytopenic purpura? Blood res. 2014; 49(4): 259-64. [Article]
2. Kowalczyk M, Rubinstein PG, Aboulafia DM. Initial Experience with the Use of Thrombopoetin Receptor Agonists in Patients with Refractory HIV-Associated Immune Thrombocytopenic Purpura A Case Series. J Int Assoc Provid AIDS Care. 2015; 14(3): 211-6. [Article]
3. Rohmer B, Valla FV, Baleydier F, Launay V, Dommange-Romero F, Pondarré C. Newly Diagnosed Immune Thrombocytopenic Purpura in Childhood: Successful Implementation of a Limited Intervention Strategy in the Setting of Pediatric Emergency Care. J Pediatr. 2015; 166(2): 480-2. [Article]
4. Rodeghiero F, Stasi R, Gernsheimer T, Michel M, Provan D, Arnold DM, et al. Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood. 2009; 113(11): 2386-93. [Article]
5. Farah RA, Hage P, Al Rifai A, Afif C. Immune thrombocytopenic purpura associated with brucellosis. Case report and review of the literature. J Med Liban. 2010; 58(4): 241-3. [Article]
6. Cecinati V, Principi N, Brescia L, Giordano P, Esposito S. Vaccine administration and the development of immune thrombocytopenic purpura in children. Hum Vaccin Immunother. 2013; 9(5): 1158-62. [Article]
7. Mantadakis E, Farmaki E, Buchanan GR. Thrombocytopenic purpura after measles-mumps-rubella vaccination: a systematic review of the literature and guidance for management. J Pediatr. 2010; 156(4): 623-8. [Article]
8. Coppo P, Veyradier A, Monge M. Acquired idiopathic thrombotic thrombocytopenic purpura: arguments for an autoimmune disease. Presse medicale (Paris, France: 1983). 2006; 35(12 Pt 2): 1876-86. [Article]
9. Journeycake JM. Childhood immune thrombocytopenia: role of rituximab, recombinant thrombopoietin, and other new therapeutics. Hematology Am Soc Hematol Educ Program. 2012; 2012(1): 444-9. [Article]
10. Son DW, Jeon IS, Yang SW, Cho SH. A single dose of anti-D immunoglobulin raises platelet count as efficiently as intravenous immunoglobulin in newly diagnosed immune thrombocytopenic purpura in korean children. J Pediatr Hematol Oncol. 2008; 30(8): 598-601. [Article]
11. Mantadakis E, Farmaki E, Thomaidis S, Tsalkidis A, Chatzimichael A. A case of immune thrombocytopenic purpura after influenza vaccination: consequence or coincidence? J Pediatr Hematol Oncol. 2010; 32(6): 227-9. [Article]
12. Celik M, Bulbul A, Aydogan G, Tugcu D, Can E, Uslu S, et al. Comparison of anti-D immunoglobulin, methylprednisolone, or intravenous immunoglobulin therapy in newly diagnosed pediatric immune thrombocytopenic purpura. J Thromb Thrombolysis. 2013; 35(2): 228-33. [Article]
13. Shahgholi E, Vosough P, Sotoudeh K, Arjomandi K, Ansari S, Salehi S, et al. Intravenous immune globulin versus intravenous anti-D immune globulin for the treatment of acute immune thrombocytopenic purpura. Indian J Pediatr. 2008; 75(12): 1231-5. [Article]
14. Blanchette VS, Price V. Childhood chronic immune thrombocytopenic purpura: unresolved issues. J Pediatr Hematol Oncol. 2003; 25: S28-33. [Article]
15. Ou CY, Hsieh KS, Chiou YH, Chang YH, Ger LP. A comparative study of initial use of intravenous immunoglobulin and prednisolone treatments in childhood idiopathic thrombocytopenic purpur. Acta Paediatr Taiwan. 2005; 47(5): 226-31. [Article]
16. El Alfy MS, Mokhtar GM, El-Laboudy MA, Khalifa AS. Randomized trial of anti-D immunoglobulin versus low-dose intravenous immunoglobulin in the treatment of childhood chronic idiopathic thrombocytopenic purpura. Acta Haematol. 2006; 115(1-2): 46-52. [Article]
17. Salama A, Kiefel V, Amberg R, Mueller-Eckhardt C. Treatment of autoimmune thrombocytopenic purpura with rhesus antibodies (anti-Rh0 (D)). Blut. 1984; 49(1): 29-35. [Article]
18. Adly AAM, Ragab IA, Ismail EAR, Farahat MM. Evaluation of the immature platelet fraction in the diagnosis and prognosis of childhood immune thrombocytopenia. Platelets. 2015; 26(7): 645-50. [Article]
19. Alavi S, Aryan Z, Ghazizadeh F, Arabi N, Nikougoftar M, Ebadi M. The immunophenotype of bone marrow lymphocytes in children with immune thrombocytopenic purpura. Pediatr Hematol Oncol. 2014; 31(6): 548-54. [Article]
20. Heitink-Pollé KM, Nijsten J, Boonacker CW, de Haas M, Bruin MC. Clinical and laboratory predictors of chronic immune thrombocytopenia in children: a systematic review and meta-analysis. Blood. 2014; 124(22): 3295-307. [Article]
21. Sfaihi L, Kassar O, Medhaffar M, Kamoun T, Hadiji S, Aloulou H, et al. Primary immune thrombocytopenia in childhood: a regional study in the south of Tunisia. Tunis Med. 2014; 92(3): 219-23. [Article]
22. Cheng Y, Wong RS, Soo YO, Chui CH, Lau FY, Chan NP, et al. Initial treatment of immune thrombocytopenic purpura with high-dose dexamethasone. N Engl J Med. 2003; 349(9): 831-6. [Article]
23. Mashhadi MA, Kaykhaei MA, Sepehri Z, Miri-Moghaddam E. Single course of high dose dexamethasone is more effective than conventional prednisolone therapy in the treatment of primary newly diagnosed immune thrombocytopenia. Daru. 2012; 20(1): 1. [Article]
24. Yetgin S, Aytaç S, Olcay L, Tunç B, Özbek N, Aydinok Y. Evaluation of the effects of and earliest response rate to anti-D treatment in children with chronic idiopathic thrombocytopenic purpura: a pilot study. Turk J Pediatr. 2010; 52(2): 126. [Article]
25. Kumar M, Vik TA, Johnson CS, Southwood ME, Croop JM. Treatment, outcome, and cost of care in children with idiopathic thrombocytopenic purpura. Am J Hematol. 2005; 78(3): 181-7. [Article]
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