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Chronic immune thrombocytopenic purpura – successful treatment with anti-CD 20 antibodies


Authors: V. Fiamoli;  J. Blatný
Authors‘ workplace: Oddělení klinické hematologie FN Brno, pracoviště FDN J. G. Mendela, vedoucí lékař MUDr. Jan Blatný, Ph. D., a Centrum pro trombózu a hemostázu MU Brno, přednosta prof. MUDr. Miroslav Penka, CSc.
Published in: Vnitř Lék 2010; 56(Supplementum 1): 64-65
Category: 16th Parizek's Days, Ostrava-Poruba, March 25th –26th 2010

Overview

Immune thrombocytopenic purpura is common bleeding disorder in children characterized by skin and mucous bleeding. There is an isolated thrombocytopenia caused by antithrombotic antibodies. The standard treatment is corticosteroids and intravenous immunoglobulins. The alternative treatment might be anti-CD 20 antibodies. Splenectomy should be considered when treatment mentioned above failed. In adult patients we can use also trombopoetin analogs as a novel approach in the therapy. We describe the case of five-year- old girl sent to our clinic with low platelet count and diffuse bruising. The intravenous immunoglobulins administered did not lead to sufficient response. Due to further decrease of thrombocytes count we commenced her on prednisone. As the initial dose of 1 mg/ kg/ day was not sufficient for clinical response, we doubled the dose. Remission was reached in two weeks after the dose change, however remained only for eight weeks. Thus we decided for alternate treatment with anti-CD 20 antibodies to prevent repeated frequent relapses. The platelet count increased progressively during this treatment and stayed stable until now. The prognosis in patients with chronic immune thrombocytopenic purpura is uncertain. The alternate treatment with anti-CD 20 antibodies might lead to the remission, prevent or at least postpone splenectomy and thus improve the quality of life.

Key words:
immune thrombocytopenia –  children –  prednisone –  intravenous immunoglobulins –  anti-CD 20 antibodies


Sources

1. Pospíšilová D. Idiopatická trombocytopenická purpura. Dětská hematologie. Praha: Galén 2005: 122– 134.

2. Starý J, Smíšek P, Spoustová L et al. Imunní (idiopatická) trombocytopenická purpura –  incidence, diagnostické a léčebné postupy v České republice. Čes Slov Pediat 2001; 96: 111– 115.

Labels
Diabetology Endocrinology Internal medicine

Article was published in

Internal Medicine

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