Comparison of Therapeutic Effectiveness and Complications of Prednisolone, IV Immunoglobulin and Rhogam in Idiopathic Thrombocytopenic Purpura in Pediatric Patients

Idiopathic thrombocytopenic purpura is a common disease in childhood. Management of thrombocytopenia includes corticosteroids, IV immunoglobulin (IVIG), Rhogam and many other interventions. In this article we study the therapeutic effects of these methods and their complications. This is a study on 32 chronic and acute ITP cases in childs who visited Dr Sheikh hospital from Jun 2004 to March 2005. Inclusion criteria was Rh+, and negative Combs test. The patients were allocated to receive one of the treatment protocols: Prednisolone (dose/time), IVIG (dose/time), or Rhogam (dose/time). The following end points were assessed: duration of treatment, the effectiveness of treatment and the side effects.Mean age was 8.35  4.5 years and male and female had similar prevalence. Petechia and purpura was the significant clinical sign found in 90.6 % of patients.Prednisolone, IVIG and Rhogam were administered to 43.8, 25, and 31 % of patients respectively. Although the initial platelet count was higher in prednisolone group, at the end of treatment all groups had similar platelet count. Compared to other treatment protocols, the Rhogam-treated group had a significantly shorter hospitalization period, more frequent complete therapeutic response, without any recurrence over the period of study, and lack of side effects such as acute hemolysis and hepatotoxicity.The results of the study suggest that Rhogam produces more rapid remission of symptoms and is a safe, effective, easy to use and cost effective. Therefore we recommend it for treatment of ITP in Rh +, and Combs negative children.