الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
ITP is an autoimmune disorder characterized by thrombocytopenia (platelet count <100 ×109/L) with or without bleeding events in the absence of other causes of thrombocytopenia. Primary ITP in children is usually self-limited, with approximately 80% of cases resolving within 6-12 months. chronic ITP persists after twelve months from diagnosis. Treatment strategy include first line therapy as corticosteroids and IVIG, second line therapy as anti-CD20 (rituximab) and TPO-RA. So, the present study aimed to establish a database for chronic ITP & to find out a scale of priority for different lines of treatment of chronic ITP through analysis of lines of treatments given and patients’ outcome. The study started with 405 children were diagnosed with ITP. Of these, 4 cases were excluded as diagnosed as secondary ITP, 298 (73.5%) had achieved remission by 1 year. Out of the remaining 103 (25.4 %), 29 patients lost the follow-up. A total of 74 children with chronic ITP and on regular follow up were included in the analysis. About one third of the patients were managed conservatively with a large percentage of sustained remission. Age of onset of disease and duration of the disease were prognostic factors for remission in conservative management. Also, about two thirds of stubied patients had received first line therapy, the response to rescue therapy (IVIg or corticosteroids) was significantly better in males than females and the highest platelet count was achieved after IVIg compared to oral steroids and IV methyl prednisolone. No significant differences were noted regarding response or sustainability to different immune modulatory treatment categories. Male patients respond better to immune modulatory therapy than females. Also, about only one third of the studied cases had received TPO-RAs. No significant differences were reported as regard response or duration or sustainability to response between the two different TPO-RAs and females respond better than males. There were no factors predicting sustained remission after withdrawal of the therapy. Conclusion: chronic ITP in children has a benign course in most of cases. Not all cases require treatment as a good percentage of cases succeeded to maintain safe platelet count without therapy. Although many therapeutic options are available for treatment of ITP, there is no single satisfactory therapeutic line for all patients. Sustainability of remission is still a problem after discontinuation of the therapy.