The Turkish Journal of Pediatrics 2010 , Vol 52 , Num 2
Evaluation of the Effects of and Earliest Response Rate to Anti-D Treatment in Children with Chronic Idiopathic Thrombocytopenic Purpura: A Pilot Study
Departments of Pediatric Hematology, 1Hacettepe University Faculty of Medicine, 2Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, 3Dr. Sami Ulus Children’s Hospital, 4Başkent University Faculty of Medicine, Ankara, and 5Ege University Faculty of Medicine, İzmir, Turkey In this pilot study, 30 (14 male, 16 female; median age: 8 years, range: 2- 18) chronic non-splenectomized idiopathic thrombocytopenic purpura (ITP) patients with Rh+ blood group and their 49 attacks were evaluated after intravenous (IV) anti-D (WinRho SDF, Cangene Corporation, Winnipeg, MB, Canada) treatment at a dose of 50 μg/kg x 3 days (n=21 cases; 35 attacks) or a single dose of 75 μg/kg (n=9 cases; 14 attacks) to define the hemostatic dose of anti-D. Five of 30 patients (22/49 attacks) were resistant to steroid, intravenous immunoglobulin (IVIG) and vincristine treatment. Hemoglobin (Hb), white blood cells (WBC), platelets (plt) and reticulocytes (ret) were evaluated before and after treatment during the follow-up in sequences on the 1st, 7th, 14th and 21st days after anti-D treatment if the patients had no symptom. All patients, even the resistant ones, experienced an increase in plt count to provide protection from bleeding (≥20x109/L in patients with symptoms, ≥10x109/L in patients without symptoms). The plt responses of one resistant and five non-resistant patients treated with a single 75 μg/kg dose of IV anti-D in 8 attacks were monitored at the 2nd, 4th, 8th, 24th and 48th hours of the treatment. A protective plt level was attained within 2 hours in 6 attacks of five non-resistant cases and in 24 hours in the remaining 2 attacks of one resistant case. This pilot study suggests that anti-D treatment in ITP patients is effective and can increase plt to a level adequate enough to protect from hemorrhage within 2 hours, when given in a 75 μg/kg dose. A few adverse events (i.e. chills, hemolysis and hemoglobinuria) resolved without intervention. Keywords : chronic idiopathic thrombocytopenic purpura, children, anti-D, earliest response rate, adverse effects.
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