657 Published by DiscoverSys | Bali Med J 2019; 8(3): 657-661 | doi: 10.15562/bmj.v8i3.1558 ORIGINAL ARTICLE ABSTRACT Open access: www.balimedicaljournal.org and ojs.unud.ac.id/index.php/bmj Platelets level response after three days therapy in children with acute Immune Thrombocytopenic Purpura (ITP): a 10 years’ experience at the tertiary hospital Ketut Ariawati, 1* I Made Karma Setiyawan 2 Background: Immune thrombocytopenic purpura (ITP) is the most common cause of thrombocytopenia in children that characterized by isolated thrombocytopenia that vary in bleeding manifestations. The onset of disease is sudden and a self-limiting condition that requires treatment when clinically signifcant bleed occurs. A treatment goal is to increase platelet level above safety level and reduce the risk of severe bleeding. This study aims to evaluate the platelets level increment after three days treatment among children with acute ITP. Methods: An analytic retrospective cross-sectional study was conducted in Haematology-Oncology Paediatric Division Sanglah General Hospital, Bali, Indonesia from October 2008 to October 2018 in ITP patients. Diagnosis of ITP was evaluated based on the clinical manifestation and laboratory fnding. Oral corticosteroid medication with dosage 2 mg/kg/day or 4 mg/kg/day with or without platelets transfusion were enrolled in this study from medical records. Data were analyzed using SPSS version 20 for Windows. Results: There were 93 children met the inclusion criteria and included in this study. A median platelets level at admission was 6.81(1-86.8) x 10 9 /L. Majority symptoms of children with ITP in our tertiary care centre presented with mild to moderate clinical bleeding symptoms. Only 5.6% children with platelets level below 10x10 9 /L had intracranial bleeding. Median platelets level was 31(2.47-382) x 10 9 /l and there was a signifcant platelets level increment after three days of therapy (P<0.05). Conclusion: The platelets level increment signifcantly in children with acute ITP after three days of therapy. Keywords: immune thrombocytopenic purpura, platelets level, oral steroid, platelets transfusion Cite this Article: Ariawati, K., Setiyawan, I.M.K. 2019. Platelets level response after three days therapy in children with acute Immune Thrombocytopenic Purpura (ITP): a 10 years’ experience at the tertiary hospital. Bali Medical Journal 8(3): 657-661. DOI: 10.15562/bmj. v8i3.1558 1 Pediatrician, Haematology- Oncology Consultant, Department of Child Health, School of Medicine, Universitas Udayana, Sanglah General Hospital, Denpasar, Bali, Indonesia 2 Pediatric Resident, Department of Child Health, School of Medicine, Universitas Udayana, Sanglah General Hospital, Denpasar, Bali, Indonesia *Corresponding to: Ketut Ariawati; Pediatrician, Haematology-oncology Consultant, Department of Child Health, School of Medicine, Universitas Udayana, Sanglah General Hospital, Denpasar, Bali, Indonesia; ketutari_hemato@yahoo.com Bali Medical Journal (Bali Med J) 2019, Volume 8, Number 3: 657-661 P-ISSN.2089-1180, E-ISSN: 2302-2914 Received: 2019-07-16 Accepted: 2019-11-25 Published: 2019-12-01 657 INTRODUCTION Immune thrombocytopenic purpura (ITP) is an acquired autoimmune haematological disorder ofen occurs in children that characterized by isolated thrombocytopenia (platelets count <100x10 9 /l) an without any systemic diseases. 1,2 Newly diagnosed/ acute ITP is thrombocytopenia self-limiting and lasting for 3 months. 3 Childhood ITP afects males and female equally but in infancy more frequent afect females. Peak occurrence is between 2 and 5 years of age. Te onset of the disease was sudden with viral illness or immunization few weeks earlier as preceding factor. 4 Previous infection as preceding factor occur in approximately 60% of pediatric ITP. 5 Clinical manifestation involving varies bleeding disorders range from mild (mucocutaneous bleeding) to severe (internal organ bleeding). It is a self-limiting disease and requires treatment only when clinically signifcant bleeding occurs. Risk of severe and internal bleeding increase up to 3% and 1% respectively. 6 Platelets count less than 10x10 9 /L is more likely to cause severe bleeding with only 3% showed signifcant symptoms as severe epistaxis or gastrointestinal (GI) bleeding. 5 Treatment varies from drugs until blood transfusion administration. Drug of choice includes corticosteroids, intravenous immunoglobulin (IVIG) and anti-D immunoglobulin with goals of therapy is to increase the platelets count enough to prevent severe bleeding. Management of ITP depends on signifcant bleeding manifestation with frst-line treatment is prednisone 2 mg/kg/day in divided doses orally for 2-4 weeks with tapering afer platelets response occurs. Another approach is to use prednisone 4 mg/kg/day for a short period with rapid taper. 2,7 IVIG and anti-D are used if platelets counts < 20x10 9 /L and active bleeding. 8 In Sanglah General Hospital setting, children with acute ITP were treated according to the manifestation of bleeding and platelets level. Initial