Retrospective Evaluation of Patients Followed-Up and Treated for Idiopathic Thrombocytopenic Purpura: A 21-Year Single-Center Experience

Abstract

Introduction: Primary immune thrombocytopenia (ITP) is an autoimmune disorder that is distinguished by a low platelet count (<100×109/L) without any other underlying causes. The aim of this study is to determine the factors affecting chronicity by retrospectively evaluating the demographic characteristics, examination findings, laboratory results, treatment regimens and treatment responses of patients followed-up for idiopathic thrombocytopenic purpura in our clinic. Materials and methods: This study retrospectively reviewed the medical records of patients diagnosed with idiopathic thrombocytopenic purpura and admitted to the Department of Paediatrics at the Faculty of Medicine from January 1, 1997, to December 31, 2018. Results: A total of 447 patients diagnosed with idiopathic thrombocytopenic purpura (ITP) between January 1997-December 2018 were identified. Four hundred twenty-eight patients were included in the study. The mean age of diagnosis in chronic ITP was higher than that of acute ITP (p=0.000). Platelet count at admission was lower in acute ITP patients than that of chronic patients (p=0.035). ANA positivity was much higher among chronic patients than in other groups (p=0.014). The difference between the platelet count at the time of diagnosis and on the 3rd day was much higher in patients on steroid and IVIG therapy than that of the patients under combined therapy (p<0.001). The 3rd and 7th-day platelet counts of patients with remission was higher than that of the patients without remission (p<0.001). Age of diagnosis, mean follow-up period, and platelet count at day 7 were identified as the risk factors for chronicity. Conclusion: It was found that older age of diagnosis, female sex, absence of upper respiratory tract infections history, high platelet count were the factors affecting chronicity in children with ITP. Keywords: Immune thrombocytopenic purpura, child, thrombocytopenia

Keywords

• Immune thrombocytopenic purpura
• child
• thrombocytopenia

İdiyopatik Trombositopenik Purpura Nedeniyle Takip ve Tedavi Edilen Hastaların Retrospektif Değerlendirmesi: Tek Merkez 21 Yıllık Deneyimi

Öz

Giriş: Primer immün trombositopeni (ITP), altta yatan başka bir neden olmaksızın düşük trombosit sayısı (<100×109/L) ile ayırt edilen otoimmün bir hastalıktır. Bu çalışmanın amacı kliniğimizde idiyopatik trombositopenik purpura nedeniyle takip edilen hastaların demografik özelliklerini, muayene bulgularını, laboratuvar sonuçlarını, tedavi rejimlerini ve tedaviye yanıtlarını retrospektif olarak değerlendirerek kronikleşmeyi etkileyen faktörleri belirlemektir. Materyal ve metot: Bu çalışmada, 1 Ocak 1997 ile 31 Aralık 2018 tarihleri arasında Tıp Fakültesi Çocuk Sağlığı ve Hastalıkları Anabilim Dalı'na başvuran ve idiyopatik trombositopenik purpura tanısı alan hastaların tıbbi kayıtları retrospektif olarak incelendi. Bulgular: Ocak 1997-Aralık 2018 tarihleri arasında idiyopatik trombositopenik purpura (İTP) tanısı alan toplam 447 hasta belirlendi. Dört yüz yirmi sekiz hasta çalışmaya dahil edildi. Kronik İTP'de ortalama tanı yaşı akut İTP'ye göre daha yüksekti (p=0.000). Başvuru sırasındaki trombosit sayısı akut İTP hastalarında kronik İTP hastalarına göre daha düşüktü (p=0,035). ANA pozitifliği kronik hastalarda diğer gruplara göre çok daha yüksekti (p=0.014). Tanı anındaki ve 3. gündeki trombosit sayısı arasındaki fark, steroid ve IVIG tedavisi gören hastalarda kombine tedavi gören hastalara göre çok daha yüksekti (p<0.001). Remisyona giren hastaların 3. ve 7. gün trombosit sayıları remisyona girmeyen hastalarınkinden daha yüksekti (p<0.001). Tanı yaşı, ortalama takip süresi ve 7. gün trombosit sayısı kronikleşme için risk faktörleri olarak belirlendi. Sonuç: İleri tanı yaşı, kız cinsiyet, üst solunum yolu enfeksiyonu öyküsünün olmaması ve yüksek trombosit sayısının İTP'li çocuklarda kronikleşmeyi etkileyen faktörler olduğu bulunmuştur.

Anahtar Kelimeler

• İmmün trombositopenik purpura
• çocuk
• trombositopeni

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