ABSTRACT
BACKGROUND: Idiopathic thromboycytopenic purpura(ITP) is one of the most common acquired bleeding disorders in childhood. The entity of chronic ITP is defined as the persistence of thrombocytopenia for more than 6 months from initial presentation. There are the controversies regarding the diagnosis and management of this disease. The aim of this study is to compare the responses to managements and clinical symptoms of children with chronic ITP. METHODS: We retrospectively analyzed patients with chronic ITP diagnosed and managed between Jan., 1992 and June, 1997. Data from 33 cases were collected. The length of follow-up ranged from 6 months to 5 years. Statistical analysis was done using Jandel Sigmastat software(version 2.0). RESULTS: 1) Mean age is 5.4+/-4.3 years. The ratio of female to male is 0.65. 2) Most common clinical symptoms at presentation were petechiae(81.8%) and mucosal bleeding(42.4%). The patients who presented only petechiae and purpurae were 18 cases(54.5%), both petechiae and mucosal bleeding were 9 cases(27.3%). 3) The platelet count was 43,015+/-39,912/mm3. Bone marrow examinations showed normal or increased megakaryocyte, no abnormal cells and normal cellularity. 4) The prolonged complete response lasting more than 6 months without maintenance therapy was attained in 15.2% of the patients. A continuous complete response was observed in 6.1% to prednisone and IV-gamma-globulin. A prolonged complete response to dexamethasone was in 23.8% and continuous complete response was in 14.3%. The splenectomy was underwent in 3 patients. All of them had a prolonged complete response. One of six patients who were treated with combination chemotherapy had a prolonged complete response. CONCLUSION: This analysis of chronic ITP patients suggests that splenectomy remains the most effective treatment and the next one is high dose dexamethasone therapy. But the number of patients was not enough, more attention should be given to the management of chronic idiopathic thrombocytopenic pupura(ITP).
Subject(s)
Child , Female , Humans , Male , Bone Marrow Examination , Dexamethasone , Diagnosis , Drug Therapy, Combination , Follow-Up Studies , Hemorrhage , Megakaryocytes , Platelet Count , Prednisone , Purpura , Purpura, Thrombocytopenic, Idiopathic , Retrospective Studies , Splenectomy , ThrombocytopeniaABSTRACT
PURPOSE: The development of fever in neutropenic cancer patients is frequently a sign of infection. Infection remains the major cause of death in the patient with cancer, primarily as a consequence of the profound alterations of normal host defences which result from the malignancy, its treatment or both. Fever in the patient with neutropenia is generally recognized as an indication of the need for prompt initiation of antibiotic therapy, but in spite of intensive efforts to identify infections in these patients and to institute appropriate antibiotic therapy, high mortality rate have continued to occur. This study was performed to identify the current etiologic agents, differences in frequency and/or type of infection in patients with hematologic malignacy as compared to those with solid tumor and to assess the period of neutropenia and treatment. METHODS: Between May 1994, and Feburuary 1994, we retrospectively evaluated 84 febrile episodes occurring in 46 patients with neoplastic diseases which were identified at Korea university hospital. Neutropenic fever has been defined as three episode of elevation of temperature above 38degrees C or a single elevation above 38.5degrees C in neutropenic patient (granulocyte<500/mm3) RESULTS: 1) Eighty-four episodes of fever and neutropenia were identified in 47 patients whose mean age was 6.6 years. 2) Thirty-three patients had leukemia or lymphma, representing 70.2% of the episodes of fever and neutropenia. 3) Microbiologically documented infection, clinically documented infection and unexplained fever accounted for 13%, 23%, 64% of the febrile episodes respectively. 4) Gastroenteritis and pharyngitis were the most common type of infection. 5) The common organism were Escherichia coli, Klebsiella pneumoniae, Staphyrococci aureus were common in decreasing order. 6) The mean duration of febrile neutropenia was 11.9 days in hematologic malignacy and 6.5 days in solid tumor. 7) The mean duration of receiving G-CSF was 13.1 days in hematologic malignancy and 5.8 days in solid tumor. 8) There was no significant difference in duration of neutropenia, times of receiving treatment and ANC level at fever in patients with MDI compared to CDI or UF. CONCLUSIONS: Gram negative bacilli are dominant pathogens of neutropenic fever in Korea university hospital.