اضداد الريزوس ام الميتيل بريدنزولون؟ الايجابيات والسلبيات في علاج فرفرية نقص الصفيحات المناعي الحادة عند الاطفال

Background& Objective: the research performed by the ITP study group in 2006[15] studying the efficacy of single dose IV-Rhesus antibodies (Anti-D) 50 ug/kg or 75 ug/kg compared to the single dose IVIG 800 mg/kg; that study revealed that both have a similar therapeutic effect. that study suggest to compare the single high dose of Anti-D withthree consecutive doses of Methyl-prednisolone in respect of: 1- Time of platelet recovery 2- The continuity of mediation effect throughout ( 6 months) 3- Side effects, hospitalization and cost. Materials & Methods: (44) Rh positive children suffering from acute ITP, with platelet count below 20000/mm3 (with no other treatment used) were submitted to receive Anti-D (Group A). (37) similar cases received Methyl-prednisolone and studied retrospectively ( Group B). Then we compered theresults.Conditions required for inclusion and application of the Anti-D: active bleeding or brain hemorrhage or low platelet (<10000/mm3 ). But when platelet count is >10000/mm3 , monitoring the patient for 3 days: and the Anti-D was applied when one of the three conditions achieved or if thrombocytopenia (<20000/mm3 ) persists after the third day. Results: We found that the rapid recovery of platelet count to above 20000/mm3 , was similar in both groups statistically. 24 hours after course duration the goal was established in 70.4% (n=31)on group A in 75% (n=28) on group B [P value = 0.29]. We have noticed also, the following points: Anti-D treatment is characterized by easier administration, a less necessity for hospitalization, and a less necessity for bone marrow aspiration, compared to Methylprednisolone. The global cost of treatment is approximately similar comparing the two medications. We have also noticed that cases refractory for anti-D were refractory also for the high-dose Methylprednsiolone course. Of the cons of Anti-D application is the risk of hemoglobinuria and inciting a hemolytic anemia, which may lower the hemoglobin concentration by a mean of 1.5 g/dL within a week. In addition, anti-D is used only in those who are Rh positive. Conclusion: A high single-dose of Anti-D can raise the platelet count rapidly to a level above the danger threshold (20000/mm3 ) in children suffering from newly diagnosed acute ITP, with better results over Methylprednisolone, taking into consideration that the study is not randomized and the sample size is small.