methyl-prednisolonate and Purpura--Thrombocytopenic--Idiopathic

Chronic ITP rarely presents with severe bleeding episodes (SBE). Number and duration of SBE were evaluated in relation to the cost of management. Out of 157 chronic ITP patients attending our institution from 1994 to 2003, 37 patients, <16 years with persistent thrombocytopenia (>6 months), suffering from SBE or platelet count<10x10(9)/L were prospectively randomized to receive either intravenous immunoglobulins (IVIG), anti-D immunoglobulin (anti-D) or high-dose methyl prednisolone (HDMP). Sixty-one patient-years were followed, during which 351 SBE were documented. The high-cost management (IVIG and anti-D) showed insignificantly better platelet recovery, less frequent SBE with shorter duration per patient, higher rate of CR, and less splenectomy in contrast to the steroid groups. The effectiveness of high-cost management compared with methyl prednisolone could not be documented in this study.

Topics: Adolescent; Child; Chronic Disease; Cost of Illness; Disease Management; Drug Administration Schedule; Egypt; Follow-Up Studies; Health Care Costs; Humans; Immunoglobulins, Intravenous; Isoantibodies; Platelet Count; Prednisolone; Prospective Studies; Purpura, Thrombocytopenic, Idiopathic; Rho(D) Immune Globulin; Severity of Illness Index; Treatment Outcome

The aim of this study was to measure the levels of B-cell-activating factor (BAFF), a proliferation-inducing ligand (APRIL), and co-stimulatory molecules in immune thrombocytopenia (ITP) of childhood to investigate the interaction between T and B lymphocytes and the impact of proliferation of B lymphocytes in the pathogenesis. Twenty newly diagnosed ITPs, 20 chronic ITPs, and 20 healthy controls between 2 and 18 years were enrolled in this study. Hemogram, BAFF, APRIL, interleukin-4, and interferon (IFN)-γ levels in sera and expressions of CD19, CD 3, CD21, CD40, and CD 154 on leukocytes were measured by ELISA and flow cytometry. Mean BAFF level in newly diagnosed ITP group was higher than the mean BAFF level in other groups. BAFF levels were significantly decreased after the treatment in newly diagnosed ITP group. APRIL, interleukin-4, and IFN-γ in newly diagnosed ITP group and BAFF, APRIL, interleukin-4, and IFN-γ in chronic ITP group were similar before and after treatment. There was no statistical difference for expressions of CD 19 and CD3 on lymphocytes, CD40 on leukocytes, CD154 on T cells, and for percentages of CD21/CD40, CD21/CD40, CD21/CD40 B cells, and CD19/CD3 lymphocytes for pretreatment and posttreatment levels in both ITP groups. In conclusion, our study strongly demonstrated that BAFF has an important role in the pathogenesis of newly diagnosed childhood ITP. It may be important in the follow-up and in novel therapy modalities of these patients.

Topics: Adolescent; Antigens, CD; B-Cell Activating Factor; B-Lymphocytes; Case-Control Studies; Cell Communication; Cell Proliferation; Child; Child, Preschool; Female; Gene Expression Regulation; Humans; Immunoglobulins, Intravenous; Interferon-gamma; Interleukin-4; Male; Prednisolone; Purpura, Thrombocytopenic, Idiopathic; Signal Transduction; T-Lymphocytes; Tumor Necrosis Factor Ligand Superfamily Member 13