Evaluation of Pediatric Immune Thrombocytopenia (ITP) Cases and Risk Factors for Chronic ITP - Single Center Experience

Year 2023, , 123 - 128, 30.08.2023

Selçuk Erdoğan , Tuba Kasap , Şahin Takçı , Ali Gül , Ergün Sönmezgöz , Erhan Karaaslan , Rüveyda Gümüşer , Osman Demir

https://doi.org/10.18678/dtfd.1203898

Abstract

Aim: Immune thrombocytopenia (ITP) is the most common acquired bleeding disorder in childhood. The study aimed to assess the demographic and clinical characteristics, and treatment responses and to evaluate their effects on chronicity in pediatric ITP cases.
Material and Methods: Primary ITP patients aged 1 month to 18 years, who were diagnosed and followed up in the Pediatrics Clinic of Tokat Gaziosmanpaşa University Hospital between January 2010 and December 2018, were retrospectively analyzed.
Results: Thirty-eight patients with a diagnosis of primary ITP were included in the study. The mean age of the patients was 94.3±53.4 (14-199) months. The female/male ratio was 1. Twenty (57.1%) patients had acute ITP, and 15 (42.9%) patients had chronic ITP. There was no significant difference between the acute ITP group and the chronic ITP group in demographic, clinical features, laboratory findings, and treatment responses. In the first 12 months, the number of admissions with a platelet count of <20 000 /mm3, the number of admissions requiring treatment, and the rate of treatment given during follow-up were significantly higher in the chronic ITP group (p=0.001, p=0.001, and p<0.001, respectively).
Conclusion: To be aware of the risk factors for the development of chronic ITP will lead to the identification of high-risk patients, decisions about treatment and follow-up, and prevent unnecessary interventions and anxiety that may occur in the patient and his/her family. According to the results of this study, frequent relapses in the first year after the diagnosis of ITP may be considered a marker for chronic ITP.

Keywords

child, acute immune thrombocytopenia, chronic immune thrombocytopenia, risk factors

Pediatrik İmmün Trombositopeni (İTP) Vakalarının ve Kronik İTP için Risk Faktörlerinin Değerlendirilmesi - Tek Merkez Deneyimi

Abstract

Amaç: İmmün trombositopeni (İTP) çocukluk çağının en sık görülen edinilmiş kanama bozukluğudur. Bu çalışmada, pediatrik İTP vakalarında demografik ve klinik özellikler ile tedavi yanıtlarının incelenmesi ve bunların kronikleşmeye olan etkilerinin değerlendirilmesi amaçlandı.
Gereç ve Yöntemler: Ocak 2010 ve Aralık 2018 tarihleri arasında Tokat Gaziosmanpaşa Üniversitesi Hastanesi Çocuk Sağlığı ve Hastalıkları Kliniği'nde tanı alan ve takip edilen, 1 ay ile 18 yaş arası primer İTP hastaları geriye dönük olarak incelendi.
Bulgular: Primer İTP tanısı olan 38 hasta bu çalışmaya dahil edildi. Hastaların yaş ortalaması 94,3±53,4 (14-199) ay idi. Kız/erkek oranı 1 idi. 20 (%57,1) hastada akut İTP, 15 (%42,9) hastada kronik İTP vardı. Akut İTP grubu ile kronik İTP grubu arasında demografik, klinik özellikler, laboratuvar bulguları ve tedavi yanıtları açısından anlamlı bir farklılık yoktu. İlk 12 ayda trombosit sayısı <20.000 /mm3 olan başvuru sayısı, tedavi gerektiren başvuru sayısı ve takipte tedavi verilme oranı kronik İTP grubunda anlamlı olarak daha yüksekti (sırasıyla, p=0.001, p=0.001 ve p<0.001).
Sonuç: Çocuklarda primer İTP’de kronikleşme için risk faktörlerinin bilinmesi, yüksek riskli hastaların tanımlanarak takip ve tedavinin planlanmasına, gereksiz girişimlerin, hasta ve ailesinde meydana gelebilecek anksiyetenin önüne geçilmesine yardımcı olacaktır. Bu çalışmanın sonuçlarına göre, İTP hastalarında tanı sonrası ilk bir yıl içinde trombositopeni ataklarının sık görülmesi, kronik İTP için bir belirteç olarak kabul edilebilir.

Keywords

çocuk, akut immün trombositopeni, kronik immün trombositopeni, risk faktörleri

References

• Matzdorff A, Meyer O, Ostermann H, Kiefel V, Eberl W, Kühne T, et al. Immune thrombocytopenia - current diagnostics and therapy: recommendations of a joint working group of DGHO, ÖGHO, SGH, GPOH, and DGTI. Oncol Res Treat. 2018;41(Suppl 5):1-30.
• Kistangari G, McCrae KR. Immune thrombocytopenia. Hematol Oncol Clin North Am. 2013;27(3):495-520.
• 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(3):e506-12.
• Neunert C, Lim W, Crowther M, Cohen A, Solberg L Jr, Crowther MA; American Society of Hematology. The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia. Blood. 2011;117(16):4190-207.
• Imbach P, Kühne T, Müller D, Berchtold W, Zimmerman S, Elalfy M, et al. Childhood ITP: 12 months follow-up data from the prospective registry I of the Intercontinental Childhood ITP Study Group (ICIS). Pediatr Blood Cancer. 2006;46(3):351-6.
• Arnold DM. Bleeding complications in immune thrombocytopenia. Hematology Am Soc Hematol Educ Program. 2015;2015:237-42.
• Klaassen RJ, Blanchette VS, Barnard D, Wakefield CD, Curtis C, Bradley CS, et al. Validity, reliability, and responsiveness of a new measure of health-related quality of life in children with immune thrombocytopenic purpura: The Kids’ ITP Tools. J Pediatr. 2007;150(5):510-5.
• Zilber R, Bortz AP, Yacobovich J, Yaniv I, Tamary H. Analysis of health-related quality of life in children with immune thrombocytopenia and their parents using the kids’ ITP tools. J Pediatr Hematol Oncol. 2012;34(1):2-5.
• Aygüneş U, Uzun Çiçek A. Psychopathological evaluation in children with chronic idiopathic thrombocytopenic purpura. J Curr Pediatr. 2022;20(1):88-96. Turkish.
• Edslev PW, Rosthøj S, Treutiger I, Rajantie J, Zeller B, Jonsson OG; NOPHO ITP Working Group. A clinical score predicting a brief and uneventful course of newly diagnosed idiopathic thrombocytopenic purpura in children. Br J Haematol. 2007;138(4):513-6.
• Chotsampancharoen T, Sripornsawan P, Duangchoo S, Wongchanchailert M, McNeil E. Predictive factors for resolution of childhood immune thrombocytopenia: Experience from a single tertiary center in Thailand. Pediatr Blood Cancer. 2017;64(1):128-34.
• Heitink-Pollé KM, Nijsten J, Boonacker CW, de Haas M, Bruin MC. Clinical and laboratory predictors of chronic immune thrombocytopenia in children: a systematic review and meta-analysis. Blood. 2014;124(22):3295-307.
• Güngör T, Arman Bilir Ö, Koşan Çulha V, Güngör A, Kara A, Azık FM, et al. Retrospective evaluation of children with immune thrombocytopenic purpura and factors contributing to chronicity. Pediatr Neonatol. 2019;60(4):411-6.
• Parlar M, Acıpayam C, Dinçer S, Güllü UU, Çobanuşağı M, Maraşlı H. Evaluation of childhood immune thrombocytopenic purpura patients according to age groups. KSU Med J. 2021;16(3):350-6. Turkish.
• Ay Y, Sarbay H. Clinical and laboratory factors affecting chronicity in children diagnosed with immune thrombocytopenia. Pamukkale Med J. 2020;13(3):535-40.
• Tamminga R, Berchtold W, Bruin M, Buchanan GR, Kühne T. Possible lower rate of chronic ITP after IVIG for acute childhood ITP an analysis from registry I of the Intercontinental Cooperative ITP Study Group (ICIS). Br J Haematol. 2009;146(2):180-4.
• Beck CE, Nathan PC, Parkin PC, Blanchette VS, Macarthur C. Corticosteroids versus intravenous immune globulin for the treatment of acute immune thrombocytopenic purpura in children: a systematic review and meta-analysis of randomized controlled trials. J Pediatr. 2005;147(4):521-7.
• Heitink-Pollé KMJ, Uiterwaal CSPM, Porcelijn L, Tamminga RYJ, Smiers FJ, van Woerden NL, et al; TIKI Investigators. Intravenous immunoglobulin vs observation in childhood immune thrombocytopenia: a randomized controlled trial. Blood. 2018;132(9):883-91.
• Söğüt G, Leblebisatan G, Barutçu A, Kılınç Y, İlgen Şaşmaz H. Evaluation of pediatric patients with immune thrombocytopenia regarding clinical course and treatment response: A retrospective single-center experience. Pediatr Pract Res. 2020;8(2):38-42.
• Aslan M, Özgen Ü, Aslan N. The retrospective evaluation of patients diagnosed with acute immune thrombocytopenic purpura and comparison of high-dose methylprednisolone and intravenous immunoglobulin. Middle East Med J. 2019;11(3):303-8. Turkish.
• Aygüneş U. Clinical features and treatment outcomes in children with idiopathic thrombocytopenic purpura: A single center’s experience. Cumhuriyet Med J. 2019;41(1):131-6.
• Yıldız I, Ozdemir N, Celkan T, Soylu S, Karaman S, Canbolat A, et al. Initial management of childhood acute immune thrombocytopenia: single-center experience of 32 years. Pediatr Hematol Oncol. 2015;32(6):406-14.
• Noris P, Klersy C, Zecca M, Arcaini L, Pecci A, Melazzini F, et al. Platelet size distinguishes between inherited macrothrombocytopenias and immune thrombocytopenia. J Thromb Haemost. 2009;7(12):2131-6.
• Negash M, Tsegaye A, G/Medhin A. Diagnostic predictive value of platelet indices for discriminating hypo productive versus immune thrombocytopenia purpura in patients attending a tertiary care teaching hospital in Addis Ababa, Ethiopia. BMC Hematol. 2016;16:18.
• Ahmed S, Siddiqui AK, Shahid RK, Kimpo M, Sison CP, Hoffman MA. Prognostic variables in newly diagnosed childhood immune thrombocytopenia. Am J Hematol. 2004;77(4):358-62.
• Chen C, Song J, Wang Q, Wang LH, Guo PX. Mean platelet volume at baseline and immune thrombocytopenia relapse in Chinese newly-diagnosed patients: a retrospective cohort study. Hematology. 2018;23(9):646-52.
• Korkmaz S, Uslu AU, Aydın B, Dogan O, Sencan M. Pre-treatment and post-treatment changes in platelet indices in patients with immune thrombocytopenia. Saudi Med J. 2013;34(6):591-6.
• Adly AA, Ragab IA, Ismail EA, Farahat MM. Evaluation of the immature platelet fraction in the diagnosis and prognosis of childhood immune thrombocytopenia. Platelets. 2015;26(7):645-50.