Abstract

Immune (idiopathic) thrombocytopenic purpura (ITP) of childhood is characterized by acquired thrombocytopenia. ITP seems to occur more often after a viral respiratory illness. Findings on physical examination are normal, other than the finding of petechiae and purpura. Anti-D is effective in the treatment of children with ITP (Rh-positive non-splenectomized patients) and with higher doses appears to have comparable results to IVIG. Our experience in treating children with ITP in Gaza strip hospitals is restricted to use of corticosteroids or IVIG. No published clinical trial on safety and efficacy of anti-D in acute ITP in children in the Gaza strip. Four cases (2 males and 2 females) were admitted to El-Nasr Pediatric hospital during the period from April 2017 to December 2017 and all of them were diagnosed as acute ITP. The youngest patient was 1 year and 10 months old and the oldest patient was 11 years. Clinical presentation included skin rash 3 caseswith oral cavity bleeding in one case. All cases had history of previous URTI 1-2 weeks before the attack of ITP.Anti-D was used for allthese cases. Dose given was 50-75mic/kg. The overall response rate was 75%, three cases showed good response and platelet count was elevated within 24 hours. The duration of hospitalization for all the responsive cases was 2 days. No side effects of Anti- D were noted.

Conclusion:Anti-D is used in pediatric age group for use in some carefully selected cases of acute ITP. Anti-D showed nearly the same efficacy and safety with cost effectiveness comparable to IVIG.

Keywords: Idiopathic Thrombocytopenic Purpura; Anti-D; IVIG

References

1. Robert M Kliegman MD. Nelson textbook 20^thedition (2016).
2. Rahul Naithani., et al.“Efficacy and Safety of Anti-D for Immune Thrombocytopenic Purpura in Children”. All India Institute of Medical Sciences, New Delhi, India.Indian Pediatrics 47 (2010).
3. “Rho (D) immune globulin: Drug information”. Up To Date version 21.6.
4. James N George., et al. “Intravenous Anti–D: another treatment for ITP, ITP support association” (2003).
5. Eric Cheung and Howard A Liebman.“Anti-RhD immunoglobulin in the treatment of immune thrombocytopenia”.Biologics Journal3 (2019): 57-62.
6. Aziz Eghbali., et al. “Comparison between IV immune globulin (IVIG) and anti-D globulin for treatment of immune thrombocytopenia: a randomized open-label study”.Fundamental and Clinical Pharmacology 30 (2016): 385-389.
7. Joanne Yacobovich., et al. “Anti-D treatment for pediatric immune thrombocytopenia: Is the bad reputation justified?”Seminares in HematologyJournal 53 (2016): S64-S66.
8. “Pediatric landmarks” (2019).
9. HyperRHO S/D Full Dose (Rho[D] Immune Globulin. Research Triangle Park, NC: Grifols Therapeutics (2012).
10. Neunert C., et al. “The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia”.American Society of Hematology16 (2011): 4190-4207.
11. Rhophylac (Rho[D] Immune Globulin). Kankakee, IL: CSL Behring (2016).

Citation

Citation: Heba Makki.,et al. “Efficacy and Safety of Anti-D for Acute Immune Thrombocytopenic Purpura in Children in El-Nasr Hospital - Case Report". Acta Scientific Paediatrics 3.8 (2020): 02-05.

Copyright

Copyright: © 2020 Heba Makki.,et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.