קצב הורדת סטרואידים

שלום, 1. מהו קצב הורדת הסטרואידים המומלץ לילד בן 4.5, כרגע הוא לוקח 30 מ"ג ליום. הרופא המטפל מוריד לו כ- 5מ"ג כל שבוע. 2. לא נראה כי הסטרואידים משפיעים על עליית רמת הטסיות (כרגע נמצא ברמה של 20000 לאחר שהיגיע ל-70000). האם קיים טיפול אחר מעבר לסטרואידים ו/או הוצאת הטחול. בהתאם למה שקראתי הוצאת טחול פותרת את הבעיה אצל פחות מ- 50% מהאנשים. 3. האם יש קשר בין חיידק הקיבה הליקובקטר ומחלת ה- ITP? 4. האם יש קשר בין רגישות לגלוטן ומחלת ה- ITP? 5. האם קיימים מחקרים המראים על אחוזי ריפוי בילדים שעברו טיפול כלשהו וכאלה שלא? תודה מראש.

קצב הורדת הסטרואידים צריך להיות איטי, אבל מדוע להוריד אם הטסיות יורדות ? אולי בגלל העובדה שהוא ילד ? לא נראה לי. אני מזכיר לך שאיני המטולוג ילדים. טיפולים אפשריים - IVIG, כריתת טחול, אנטי D, טיפולים אימונוסופרסיביים. נכון שיש מקרים שנשארים עם ITP כרוני למרות הכל, אבל אפשר גם לגדול ולחיות עם ITP כרוני ואפילו עם טרומבוציטופניה של 20000. אכן, עשוי להיות קשר בין הליקובקטר ובין ITP. יש דיווחים כאלה לאחרונה וגם על כך שעקירת ההליקובקטר משפרת את מצב ה- ITP. ראה: http://www.haematologica.it/abstr/grimaz843.html וגם Blood 2001 Feb 1;97(3):812-4 Related Articles, Books, LinkOut Helicobacter pylori eradication can induce platelet recovery in idiopathic thrombocytopenic purpura. Emilia G, Longo G, Luppi M, Gandini G, Morselli M, Ferrara L, Amarri S, Cagossi K, Torelli G. Department of Medical Sciences, Section of Internal Medicine and Hematology, and Department of Paediatrics, University of Modena, Italy. [email protected] Recent reports have suggested an association between Helicobacter pylori infection and idiopathic thrombocytopenic purpura (ITP). The prevalence of H pylori infection and the effect of its eradication in a series of 30 ITP patients were investigated. H pylori infection has been documented in 13 patients (43.33%) by 13C urea breath test and confirmed by histologic examination. Bacterium eradication with antibiotics, obtained in 12 of 13 infected patients (92.3%), led to a complete response in 4 (33.33%) and to a partial response (platelets 90 x 10(9)/L-120 x 10(9)/L) in 2 (16.66%). The response was maintained for a median of 8.33 months, but 1 patient relapsed 7 months after eradication. Search for H pylori infection seems appropriate in ITP patients at diagnosis. Bacterium eradication provides a new good option for a nonimmunosuppressive treatment in some ITP patients. לגבי גלוטן - כנראה לא. ראיתי מכתב של מישהי שכתבה שהחלימה מ- ITP כאשר עברה לדיאטה חופשית מגלוטן, אבל לא בספרות הרפואית. יש תיאור מקרה של ילד שסבל מ- ITP ומצליאק, אך ללא תלות בין שתי המחלות. Acta Paediatr Scand 1988 Sep;77(5):764-6 Related Articles, Books, LinkOut Thrombocytopenic purpura and coeliac disease. Stenhammar L, Ljunggren CG. Department of Paediatrics, Central Hospital, Norrkoping, Sweden. In a child with immune thrombocytopenic purpura (ITP) the findings of circulating reticulin antibodies and IgA and IgG gliadin antibodies suggested the diagnosis of coeliac disease. This was verified by small intestinal biopsy. In spite of a gluten-free diet the thrombocytopenia persisted. The association of ITP and coeliac disease was previously described in adults but to our knowledge this is the first report of the coexistence of ITP and coeliac disease in a child ועוד מקור ל- ITP http://rarediseases.about.com/cs/itp ועוד 2 ציטוטים Ann Hematol 2001 Dec;80(12):728-32 Related Articles, Books, LinkOut Effects of prednisone and splenectomy in patients with idiopathic thrombocytopenic purpura: only splenectomy induces a complete remission. Louwes H, Vellenga E, Houwerzijl EJ, de Wolf JT. Department of Nuclear and Internal Medicine, Martini Hospital, 9700 RB Groningen, The Netherlands. Idiopathic thrombocytopenic purpura (ITP) is a heterogeneous disease, whereby it is unclear if and in which way prednisone and splenectomy affect the platelet kinetics leading to a complete remission. To determine the effects of prednisone and splenectomy on the mean platelet life (MPL) and platelet production, platelet kinetic studies with Indium-111 tropolonate-labeled autologous platelets were performed in patients with ITP ( n=41). In 17 patients platelet kinetic studies were performed before and during prednisone treatment, and in 24 patients before and after splenectomy. MPL increased after prednisone therapy only in patients ( n=13) with a full recovery (FR, platelets >150 x 10(9)/l) and partial recovery (PR, 50 x 10(9)/l <platelets <150 x 10(9)/l) from 2.1+/-1.5 days to 4.9+/-1.3 days in FR patients (p=0.03) and from 1.1+/-0.8 days to 2.4+/-1.1 days in PR patients, which is significantly shorter than in normal controls (9.2+/-1.2, p<0.0001). The platelet production demonstrated an impressive increase (threefold) during prednisone treatment in all responding and nonresponding patients. These results suggest that the clinical response to prednisone is more related to the effect on MPL than on platelet production. In contrast, the group of splenectomized patients showed that a full recovery of platelet count was associated with near normalization of the MPL (2.4+/-1.6 days vs 8+/-1.4 days) and platelet production (119+/-60 vs 162+/-35 x 10(9)/day). These results demonstrate that prednisone as well as splenectomy increase MPL and production in patients with ITP. However, only after splenectomy is a complete remission obtained, defined as a normal platelet count, mean platelet life, and platelet production. PMID: 11797113 [PubMed - indexed for MEDLINE] -------------------------------------------------------------------------------- 2: Lancet 2001 Dec 22-29;358(9299):2122-5 Related Articles, Books, LinkOut Newly diagnosed idiopathic thrombocytopenic purpura in childhood: an observational study. Kuhne 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, Romergasse 8, CH-4005, Basel, Switzerland. [email protected] 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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