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Factors Affecting Chronicity in Childhood Immune Thrombocytopenia

Year 2019, Volume: 7 Issue: Ek - IRUPEC 2019 Kongresi Tam Metin Bildirileri, 227 - 234, 10.12.2019

Abstract

Immune thrombocytopenic purpura (ITP) is the most common cause of childhood acquired thrombocytopenia. Spontaneous recovery within one year is common in acute cases. Whereas intravenous immunoglobulin (IVIG), corticosteroids or anti Rh immunoglobulin (Anti-D) treatments are used to increase the platelet count rapidly in cases with high risk of bleeding or those with hemorrhage. We aimed to evaluate initial responses to various treatments in childhood ITP and factors affecting chronicity in a single center cohort of pediatric and adolescent ITP patients.

MATERIALS AND METHOD:
The study included 143 patients under the age of 18 who were followed-up with the diagnosis of ITP and who presented within initial 12 months of the disease within 18 years of duration. The initial treatment responses of acute ITP and the factors influencing chronicity were evaluated.

FINDINGS:
Of the 143 patients nine were lost the follow up, 81 patients (60,4%) exhibited resolution of thrombocytopenia within 12 months. The sex and mean age were not different between acute(aITP) and chronic(cITP) patients (p>0,05). But aITP was more frequent below two years old (p=0,027). Patients who had insidious onset, who didn’t have antecedent history of infection had higher chronicity rates. Platelet count at diagnosis was higher in cITP group (p=0,037). The median platelet count in the patients with cITP was 13,000(1000-122,000), which was significantly higher than in acute cases 8000(1000-62000)/mm3(p=0.037). Observation only, methylprednisolone(MP) and IVIG applied to aITP patients as initial therapies, and they had similar initial resolution/response rates (89,5%, 82,5%, 87,1% respectively)(p=0,811). Steroid and IVIG therapies provided response faster than observation only (p<0,05).

CONCLUSION:
There is higher risk of progression to chronicity from acute disease in patients with an insidious disease onset, not having history of previous infection, and higher platelet counts at diagnosis. Although the initial response rates to different treatment options in aITP were similar, responses to MP and IVIG were faster.

References

  • References 1. Devecioğlu, Ö., Kanama ve pıhtılaşma bozuklukları. Trombositopenik purpuralar. ,In: O. Neyzi, Editor. Pediatri., Nobel Tıp Kitabevleri, İstanbul; 2002. p. 1078-1084. . 2. Ghanima, W., P. Holme, and G. Tjønnfjord, Immune thrombocytopenia--pathophysiology and treatment. Tidsskrift for den Norske laegeforening: tidsskrift for praktisk medicin, ny raekke, 2010. 130(21): p. 2120-2123. 3. DB, W., Acquired Platelet Defects in Immun thrombocytopenic purpura., In: O.S. Nathan DG, Gingsburg D, Look TA, , Editor. Nathan and Oski’s Hematology of Infancy and Childhood, , W.B Saunders Company: Philadelphia. 2009; p. 1557-1590. 4. Zeller, B., et al., Childhood idiopathic thrombocytopenic purpura in the Nordic countries: epidemiology and predictors of chronic disease. Acta paediatrica, 2005; 94(2):178-184. 5. Sutor, A.H., A. Harms, and K. Kaufmehl. Acute immune thrombocytopenia (ITP) in childhood: retrospective and prospective survey in Germany. in Seminars in thrombosis and hemostasis.. Copyright© 2001 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, 2001, USA. 6. Rodeghiero, F., 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(11):2386-2393. 7. Vranou, M., et al., Recurrent idiopathic thrombocytopenic purpura in childhood. Pediatric blood & cancer 2008;51(2):261-264. 8. Kalpatthi, R. and J.B. Bussel, Diagnosis, pathophysiology and management of children with refractory immune thrombocytopenic purpura. Current opinion in pediatrics 2008;20(1):8-16. 9. Edslev, P.W., et al., A clinical score predicting a brief and uneventful course of newly diagnosed idiopathic trombocytopenic purpura in children. British journal of haematology 2007;138(4):513-516. 10. Medeiros, D. and G.R. Buchanan, Major hemorrhage in children with idiopathic thrombocytopenic purpura: immediate response to therapy and long-term outcome. The Journal of pediatrics. 1998;133(3):334-339. 11. Ozsoylu, S. and G. Erturk, Oral megadose methylprednisolone for childhood acute idiopathic thrombocytopenic purpura. Blood 1991;77(8):1856-1857. 12. Provan, D., et al., International consensus report on the investigation and management of primary immune thrombocytopenia. Blood 2010;115(2):168-186. 13. Özsoylu, S., T.R. Sayli, and G. Öztürk, Oral megadose methylprednisolone versus intravenous immunoglobulin for acute childhood idiopathic thrombocytopenic purpura. Pediatric hematology and oncology 1993;10(4):317-321. 14. Duru, F., et al., Clinical course of children with immune thrombocytopenic purpura treated with intravenous immunoglobulin G or megadose methylprednisolone or observed without therapy. Pediatric hematology and oncology 2002;19(4):219-225. 15. Tarantino, M.D., et al., Single dose of anti-D immune globulin at 75μg/kg is as effective as intravenous immune globulin at rapidly raising the platelet count in newly diagnosed immune thrombocytopenic purpura in children. The Journal of pediatrics 2006;148(4):489-494. 16. Koçak, Ü., et al., Evaluation of clinical characteristics, diagnosis and management in childhood immune thrombocytopenic purpura: a single center's experience. Turkish journal of pediatrics 2007;49(3):250. 17. Kühne, T., 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∗. The Journal of pediatrics 2003;143(5):605-608. 18. Kühne, T., et al., Newly diagnosed idiopathic thrombocytopenic purpura in childhood: an observational study. The lancet 2001;358(9299):2122-2125.
Year 2019, Volume: 7 Issue: Ek - IRUPEC 2019 Kongresi Tam Metin Bildirileri, 227 - 234, 10.12.2019

Abstract

References

  • References 1. Devecioğlu, Ö., Kanama ve pıhtılaşma bozuklukları. Trombositopenik purpuralar. ,In: O. Neyzi, Editor. Pediatri., Nobel Tıp Kitabevleri, İstanbul; 2002. p. 1078-1084. . 2. Ghanima, W., P. Holme, and G. Tjønnfjord, Immune thrombocytopenia--pathophysiology and treatment. Tidsskrift for den Norske laegeforening: tidsskrift for praktisk medicin, ny raekke, 2010. 130(21): p. 2120-2123. 3. DB, W., Acquired Platelet Defects in Immun thrombocytopenic purpura., In: O.S. Nathan DG, Gingsburg D, Look TA, , Editor. Nathan and Oski’s Hematology of Infancy and Childhood, , W.B Saunders Company: Philadelphia. 2009; p. 1557-1590. 4. Zeller, B., et al., Childhood idiopathic thrombocytopenic purpura in the Nordic countries: epidemiology and predictors of chronic disease. Acta paediatrica, 2005; 94(2):178-184. 5. Sutor, A.H., A. Harms, and K. Kaufmehl. Acute immune thrombocytopenia (ITP) in childhood: retrospective and prospective survey in Germany. in Seminars in thrombosis and hemostasis.. Copyright© 2001 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, 2001, USA. 6. Rodeghiero, F., 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(11):2386-2393. 7. Vranou, M., et al., Recurrent idiopathic thrombocytopenic purpura in childhood. Pediatric blood & cancer 2008;51(2):261-264. 8. Kalpatthi, R. and J.B. Bussel, Diagnosis, pathophysiology and management of children with refractory immune thrombocytopenic purpura. Current opinion in pediatrics 2008;20(1):8-16. 9. Edslev, P.W., et al., A clinical score predicting a brief and uneventful course of newly diagnosed idiopathic trombocytopenic purpura in children. British journal of haematology 2007;138(4):513-516. 10. Medeiros, D. and G.R. Buchanan, Major hemorrhage in children with idiopathic thrombocytopenic purpura: immediate response to therapy and long-term outcome. The Journal of pediatrics. 1998;133(3):334-339. 11. Ozsoylu, S. and G. Erturk, Oral megadose methylprednisolone for childhood acute idiopathic thrombocytopenic purpura. Blood 1991;77(8):1856-1857. 12. Provan, D., et al., International consensus report on the investigation and management of primary immune thrombocytopenia. Blood 2010;115(2):168-186. 13. Özsoylu, S., T.R. Sayli, and G. Öztürk, Oral megadose methylprednisolone versus intravenous immunoglobulin for acute childhood idiopathic thrombocytopenic purpura. Pediatric hematology and oncology 1993;10(4):317-321. 14. Duru, F., et al., Clinical course of children with immune thrombocytopenic purpura treated with intravenous immunoglobulin G or megadose methylprednisolone or observed without therapy. Pediatric hematology and oncology 2002;19(4):219-225. 15. Tarantino, M.D., et al., Single dose of anti-D immune globulin at 75μg/kg is as effective as intravenous immune globulin at rapidly raising the platelet count in newly diagnosed immune thrombocytopenic purpura in children. The Journal of pediatrics 2006;148(4):489-494. 16. Koçak, Ü., et al., Evaluation of clinical characteristics, diagnosis and management in childhood immune thrombocytopenic purpura: a single center's experience. Turkish journal of pediatrics 2007;49(3):250. 17. Kühne, T., 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∗. The Journal of pediatrics 2003;143(5):605-608. 18. Kühne, T., et al., Newly diagnosed idiopathic thrombocytopenic purpura in childhood: an observational study. The lancet 2001;358(9299):2122-2125.
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Details

Primary Language English
Subjects Health Care Administration
Journal Section Congress Proceedings
Authors

Emine Çamtosun

Mualla Çetin This is me

Publication Date December 10, 2019
Acceptance Date January 16, 2020
Published in Issue Year 2019 Volume: 7 Issue: Ek - IRUPEC 2019 Kongresi Tam Metin Bildirileri

Cite

Vancouver Çamtosun E, Çetin M. Factors Affecting Chronicity in Childhood Immune Thrombocytopenia. pediatr pract res. 2019;7(Ek):227-34.