Factors Affecting Chronicity in Childhood Immune Thrombocytopenia

Yıl 2019, Cilt: 7 Sayı: Ek - IRUPEC 2019 Kongresi Tam Metin Bildirileri, 227 - 234, 10.12.2019

Emine Çamtosun Mualla Çetin

Öz

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.

Anahtar Kelimeler

Itp, Childhood, Treatment

Kaynakça

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