Outcome of therapies for children with persistent/ chronic primary immune thrombocytopenia at a specialised haematology clinic in Durban, South Africa: The role of splenectomy
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Abstract
Background. Variance in treatment options and outcomes for patients with persistent/chronic immune thrombocytopenia (ITP) makes the selection of therapies challenging.
Objective. To describe the response rates and adverse effects of secondary therapies utilised in the management of children with persistent/ chronic ITP.
Methods. This retrospective, single-centre study reviewed clinical records of children with persistent or chronic ITP managed at Inkosi Albert Luthuli Central Hospital from 2010 to 2020. Data were extracted from the electronic-based registry using the Meditech filing system. We captured patients’ demographics, clinical features, laboratory data and therapeutic interventions. Outcomes assessed included remission and relapse rates and adverse effects post therapy.
Results. Of the 30 patients enrolled, 14 (46.7%) received immunosuppressive agents alone (azathioprine, rituximab, ciclosporin and/or prednisone) and 16 (53.3%) had splenectomy in addition to treatment with immunosuppressive agents. Of the 16 splenectomy patients, 11 (68.8%) had a complete response by 12 months of diagnosis and only 7 (43.8%) had remission at 2- to 10-year follow-up. Remission was noted in 9 of the 14 children (64.4%) treated with immunosuppressive therapy alone, at study end. The rates of side-effects in both groups were statistically non-significant (p>0.05).
Conclusion. Selection of secondary therapies including splenectomy for patients with non-acute primary ITP remains difficult and should be applied on the basis of availability, costs, social circumstances and safety of the intervention.
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