Tehran University Medical Journal

Background: The most common cause for acute onset of thrombocytopenia in an otherwise well child is (autoimmune) idiopathic thrombocytopenic purpura (ITP). The incidence of ITP appears to be greater in children than in adult. The incidence of ITP in children is estimated to be approximately 46 new cases per million population per year. Prednisolone, typically given as a single dose of 1-4 mg/kg/day, is indicated for all patients with symptomatic thrombocytopenic purpura and probably for all patients with platelet counts below 30000-50000/μL who may be at increased risk for hemorrhagic complication. An alternative to corticosteroid therapy for ITP is IVIG, but is much more expensive, has significant side effects, and is not significantly superior to steroid therapy to justify the expense and side effects of its use. In acute ITP, 80% of patients respond initially, with more rapid increase in platelet counts compared to steroid treatment. To the best of our knowledge, this is the first study in Iran comparing the efficacy of prednisolone and IVIG in the treatment of ITP.

Methods: In this retrospective study, 202 ITP patients were treated with either prednisolone or IVIG between 1995 and 2005 at the Childrens' Medical Center, Tehran, Iran. We compared the efficacy of prednisolone and IVIG in increasing the platelet counts of ITP patients. In addition, we collected the following patient data: seasonal incidence, age distribution, gender, parental consanguinity, and platelet count on admission.

Results: There were no meaningful differences between IVIG and prednisolone in the treatment of ITP (z test with p<0.05). ITP was more common in males, with the highest incidence in the age range of 2-8 years old.

Conclusion: Because there was no statistical difference between the outcome of the IVIG and prednisolone treatments, we recommend that prednisolone be the drug of choice to treat ITP.