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Newly diagnosed idiopathic thrombocytopenic purpura in childhood: an observational study.
Lancet. 2001 Dec 22-29;358(9299):2122-5.
Kühne T, Imbach P, Bolton-Maggs PH, Berchtold W, Blanchette V, Buchanan GR; Intercontinental Childhood ITP Study Group.
Divisions
of Oncology/Haematology, University Children's Hospital, Postfach,
Römergasse 8, CH-4005, Basel, Switzerland.
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BACKGROUND:
Diagnosis and management of idiopathic thrombocytopenic purpura (ITP)
have been based primarily on expert opinion and practice guidelines
rather than on evidence. We have used a registry to prospectively
survey the presenting features and the diagnostic evaluation and
management practices used for children with ITP worldwide. METHODS: We
used the Intercontinental Childhood ITP Registry which had been widely
advertised. 209 physicians from 136 institutions in 38 countries
participated by submitting data for each of their newly diagnosed
patients.
Data from 2031 children with ITP was registered between June,
1997, and May, 2000, and we analysed 6-month follow-up data from 1496
children. FINDINGS: There was a peak in occurrence of childhood ITP
during spring and a nadir in the autumn. Mean initial platelet count
was 15.4x10(9)/L (SD 19.7). 1447 (73%) of 1976 children were admitted
to hospital. Initial management consisted of no drug treatment in 612
(31%), intravenous immunoglobulin in 576 (29%), corticosteroids in 651
(33%), or both in 137 (7%) patients. Intracranial haemorrhage was
reported in two patients. INTERPRETATION: The variable approaches to
management of childhood ITP demonstrate the need for prospective
clinical trials, which should be feasible within such a study group.
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