Therapeutic Efficacy of a Single Dose of Anti-D Immunoglobulin 50 microgram/kg in Childhood Acute Immune Thrombocytopenic Purpura

BACKGROUND: To investigate the efficacy and adverse effects of a single dose of anti-D immunoglobulin (50 microgram/kg) in Korean children with acute immune thrombocytopenic purpura (ITP). METHODS: We serially evaluated the platelet count in 21 acute ITP patients that were treated with anti-D immunoglobulin (50 microgram/kg) to determine how many patients achieved platelet counts over the levels of 20 x 10(3)/mm3, 50 x 10(3)/mm3 and 100 x 10(3)/mm3 after the infusion of anti-D immunoglobulin. In addition, constitutional symptoms were monitored and changes in the hemoglobin levels were serially evaluated. RESULTS: By three days after treatment, 90.5% of the patients had achieved a platelet count over 20 x 10(3)/mm3. At seven days after treatment, 66.7% of patients achieved a platelet count of 50 x 10(3)/mm3. In addition, at seven days after treatment 61.9% of patients achieved a platelet count of 100 x 10(3)/mm3. Constitutional adverse symptoms were observed 61.9% of patients, and the symptoms diminished spontaneously without any severe sequelaes. The decline of hemoglobin concentration after treatment recovered to the initial level after two weeks. CONCLUSION: A single dose of anti-D immunoglobulin (50 microgram/kg)was effective in Korean children with acute ITP to raise the platelet count rapidly. The adverse effects of anti-D immunoglobulin, including hemolytic anemia, were not severe to prevent the use of the anti-D.

Experience of Milrinone Treatment for Persistent Pulmonary Hypertension of the Newborn

PURPOSE:Persistent pulmonary hypertension of the newborn (PPHN) is life threatening neonatal disease. Nitric oxide (NO) has been proven to improve oxygenation, however its usage is limited and 30% of patients with PPHN are NO nonresponders. Milrinone decreases right ventricular afterload and has selective pulmonary vasodilator effect. We studied the effects of milrinone on neonates with respiratory failure originated in PPHN. METHODS:Six neonates, who had oxygen index above 20 and responded poorly to other management, were treated with intravenous milrinone after confirming pulmonary hypertension with echocardiography. We reviewed their medical records retrospectively. Intravenous milrinone was started at a dose of 0.375 microgram/kg/min. Respiratory indices (Oxygenation index [OI], ventilation settings, and arterial blood gas) and cardiovascular stability (mean arterial pressure and heart rate) were documented just before; and at 6, 12, 24, 36, 48, and 72 hours after commencement of milrinone therapy. The primary outcome was the effect of milrinone on oxygenation, which was 40% reduction in OI. RESULTS:Primary cause of PPHN was meconium aspiration syndrome in three infants, respiratory distress syndrome (RDS) in the other three. Milrinone was commenced at a median age of 22.3+/-6.1 hours with a dose of 0.375 microgram/kg/min except one infant (0.5 microgram/kg/min) and infants were treated for median 58.3+/-16.7 hours. OI of all infants showed 40% reduction within 24 hours. There were no mortality, and no infants with hypotension, and intraventricular hemorrhage. CONCLUSION:Milrinone proved to be effective for PPHN by improving oxygenation. It did not cause any complications in clinical trials for newborns. It is suggested that Milrinone can replace NO or can be used as adjunct to NO in the treatment of PPHN.

Prevention and Dissociation of the Platelet Aggregation in a Patient with EDTA-dependent Pseudothrombocytopenia by Supplementation of Kanamycin: A Case Report / 소아과

Pseudothrombocytopenia is usually associated with anticoagulant ethylene diaminetetraacetic acid (EDTA). The platelet clumping that occurs in EDTA-dependent pseudothrombocytopenia (EDPT) can sometimes be prevented by the use of other anticoagulants such as heparin or sodium citrate. As an alternative, we used kanamycin before or after the withdrawal of EDTA-anticoagulated blood in a 6-year-old boy with EDPT. Kanamycin used supplementarily during the differentiation of EDPT effectively prevented platelet clumping.