İmmun trombositopenili çocuklarda kronikleşmeyi etkileyen klinik ve laboratuvar faktörler

Year 2020, Volume: 13 Issue: 3, 535 - 540, 18.09.2020

Yılmaz Ay , Hakan Sarbay

https://doi.org/10.31362/patd.695982

Cited By: 1

Abstract

Purpose: Immune thrombocytopenia (ITP) is one of the most common hematologic disorders in childhood. Approximately 20-25% of patients with newly diagnosed ITP become chronic. We aimed to investigate the risk factors that may affect chronicity of ITP.
Materials and Methods: A total of 75 pediatric patients with ITP who were admitted to the Pediatric Hematology Department of Pamukkale University Faculty of Medicine Hospital between January 2013 and July 2018 were included in the study. The patients’ characteristics such as clinical features, laboratory results, treatment requirements and type of treatment were retrospectively evaluated using the hospital's information system.
Results: 46 (79,3%) of the 58 patients with ITP were acute and 12 (20,7%) of those were chronic. The mean age of the patients with acute ITP were 4 ± 3,84 years, while the mean age of the patient with chronic ITP were 9,6 ± 4,6 years. Statistical analysis revealed that children with a diagnosis age greater than 10 years had a significantly higher rate of chronicity. The dominant season in acute cases was spring with 34,8%, while in chronic cases it was summer with 50%. Acute cases were significantly higher in the spring season. 26 of 46 patients with acute ITP (56,5%) and 3 of 12 patients with chronic ITP (25%) were treated with IVIG firstly.
Conclusion: We determined that in newly diagnosed patients with ITP who are older 10 years of age and no history of infection may have high risk of chronicity, while the patients diagnosed in the spring and administered IVIG may have less chronicity.

Keywords

Immune thrombocytopenia, pediatric, chronic

Clinical and laboratory factors affecting chronicity in children diagnosed with immune thrombocytopenia

Abstract

Abstract
Purpose: Immune thrombocytopenia (ITP) is one of the most common hematologic disorders in childhood.
Approximately 20-25% of patients with newly diagnosed ITP become chronic. We aimed to investigate the risk
factors that may affect chronicity of ITP.
Materials and methods: A total of 75 pediatric patients with ITP who were admitted to the Pediatric Hematology
Department of Pamukkale University Faculty of Medicine Hospital between January 2013 and July 2018 were
included in the study. 17 of the 75 cases were excluded, because 13 of those had lack of data in the system
and 4 of those were persistent ITP. The patients’ characteristics such as clinical features, laboratory results,
treatment requirements and type of treatment were retrospectively evaluated using the hospital's information
system.
Results: 46 (79.3%) of the 58 patients with ITP were acute and 12 (20.7%) of those were chronic. The mean age
of the patients with acute ITP was 4±3.84 years, while the mean age of the patient with chronic ITP was 9.6±4.6
years. Statistical analysis revealed that children with a diagnosis age greater than 10 years had a significantly
higher rate of chronicity. The dominant season in acute cases was spring with 34.8%, while in chronic cases it
was summer with 50%. Acute cases were significantly higher in the spring season. 26 of 46 patients with acute
ITP (56.5%) and 3 of 12 patients with chronic ITP (25%) were treated with IVIG firstly.
Conclusion: We determined that in newly diagnosed patients with ITP who are older 10 years of age and no
history of infection may have high risk of chronicity, while the patients diagnosed in the spring and administered
IVIG may have less chronicity. 

Keywords

Immune thrombocytopenia, pediatric, chronic

References

• References 1) Higashigawa M, Maeyama T, Yoshino A. Incidence of childhood idiopathic thrombocytopenic purpura. Pediatr Int 2015; 57: 1041-1043. https://doi.org/10.1111/ped.12788 2) Cines DB, Cuker A, Semple JW. Pathogenesis of immune thrombocytopenia. Presse Med 2014; 43: 49-59. https://doi.org/10.1016/j.lpm.2014.01.010 3) Rodeghiero F, Stasi R, Gernsheimer T, et al. Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood 2009; 113: 2386-2393. https://doi.org/10.1182/blood-2008-07-162503 4) ElAlfy M, Farid S, Abdel Maksoud A. Predictors of chronic idiopathic thrombocytopenic purpura. Pediatr Blood Cancer 2010; 54: 959-962. https://doi.org/10.1002/pbc.22481 5) Heitink-Pollé K, Nijsten J, Boonacker C, Boonacker CW, de Haas M, Bruin MC. Clinical and laboratory predictors of chronic immune thrombocytopenia in children: systematic review and meta-analysis. Blood 2014; 124: 3295-3307. https://doi.org/10.1182/blood-2014-04-570127 6) Kühne T, Buchanan GR, Zimmerman S, et al. A prospective comparative study of 2540 infants and children with newly diagnosed idiopathic thrombocytopenic purpura (ITP) from the Intercontinental childhood ITP study group. J Pediatr 2003; 143: 605-608. https://doi.org/10.1067/s0022-3476(03)00535-3 7) Zeller B, Rajantie J, Hedlund-Treutiger I, et al. Childhood idiopathic thrombocytopenic purpura in the Nordic countries: epidemiology and predictors of chronic disease. Acra Paediatr 2005; 94: 178-184. https://doi.org/10.1111/j.1651-2227.2005.tb01887.x 8) Kühne T, Imbach P, Bolton-Maggs PH, Berchtold W, Blanchette V, Buchanan GR. International Childhood ITP Study Group. Newly diagnosed idiopathic thrombocytopenic purpura in childhood: an observational study. Lancet 2001; 358: 2122-2125. https://doi.org/10.1016/S0140-6736(01)07219-1 9) Akbayram S, Dogan M, Ustyol L, et al. The clinical outcome of 260 pediatric ITP patients in one center. Clin Appl Thromb Hemost 2011; 17: 30-35. https://doi.org/10.1177/1076029610379849 10) Bruin M, Bierings M, Uiterwaal C, et al. Platelet count, previous infection and FCGR2B genotype predict development of chronic disease in newly diagnosed idiopathic thrombocytopenia in childhood: results of a prospective study. Br J Haematol 2004; 127: 561-567. https://doi.org/10.1111/j.1365-2141.2004.05235.x 11) Glanz J, France E, Xu S, Hayes T, Hambidge S. A population-based, multisite cohort study of the predictors of chronic idiopathic thrombocytopenic purpura in children. Pediatrics 2008; 121: 506-512. https://doi.org/10.1542/peds.2007-1129 12) Intercontinental Childhood ITP Study Group32- Kubota M, Usami I, Kobayashi K, Tsutsui T, Matsubara K. Serum immunoglobulin levels at onset: association with the prognosis of childhood idiopathic thrombocytopenic purpura. Int J Hematol 2003; 77: 304-307. https://doi.org/10.1007/bf02983791 13) Roganovic J, Letica-Crepulja M. Idiopathic thrombocytopenic purpura: a 15-year natural history study at the Children’s Hospital Rijeka, Croatia. Pediatr Blood Cancer 2006; 47: 662-664. 14) Sohn YM, Park CS, Kim KY. Idiopathic thrombocytopenic purpura in children: clinical prognosis and evaluation of treatment. Yonsei Med J. 1986; 27: 67-75. 15) Yaprak I, Atabay B, Durak I, Türker M, Öniz H, Arun Özer E. Variant clinical courses in children with immune thrombocytopenic purpura: Sixteen year experience of a single medical center. Turk J Hematol 2010; 27: 147-155. 16) Watts RG. Idiopathic thrombocytopenic purpura: a 10-year natural history study at the childrens hospital of alabama. Clin Pediatr (Phila) 2004; 43: 691-702. 17) Simons SM, Main CA, Yaish HM. Idiopathic thrombocytopenic purpura in children. J Pediatr 1975; 87: 16-22. 18) Rand ML, Wright JF. Virus associated idiopathic thrombocytopenic purpura. Transfus Sci 1998; 19: 253-259.