Evaluation of Immune Thrombocytopenic Purpura Cases: A Single Center Experience

Öz

Aim: Due to risk of severe bleeding of the organs and inveteracy acute immune thrombocytopenic purpura (ITP) is a disease that still preserves importance. In our region, cases of ITP retrospectively reviewed in terms of clinical characteristics and responses to the treatment options. Matarial and Methods: Acute and chronic cases, patients who are presenting symptoms over the age of two years and under two years of age were compared in terms of symptoms, examination findings and responses to the treatment options. Results: A total of 151 patients (male n=78, female n=73) and mean age was 5.1±3.4 years were included. The ratios of acute and chronic patients' were 75% and 25%, retrospectively. Chronicity rate was higher in patients more than two years age (p=0.01). The most frequently presenting symptom was skin lesions and 64.6% of patients with silent symptoms developed chronic immune thrombocytopenic purpura. Seasonal factors and gender had no effect on acute and chronic immune thrombocytopenic purpura (p=0.119, p=0.061). The chronicity rate of patients who have partial remission at the end of the steroid treatment as a first-line treatment option was found (p=0.001). In acute ITP cases high rate of positive response was found to steroid therapy (p=0.04). Conclusions: The clinical characteristics of the patients in our region are similar to other reported cases in our country. Economic and effective treatment selection to preventing morbidity and mortality due to disease in patients was thought to make a positive contribution of the disease prognosis. Key words: ITP; Childhood; Treatment.

Anahtar Kelimeler

• ITP; Childhood; Treatment.

İmmün Trombositopenik Purpura Olgularımızın Değerlendirilmesi: Tek Merkez Deneyimi

Öz

Amaç: Akut immün trombositopenik purpura çocukluk çağında ciddi organ kanamaları ve kronikleşme riskinden dolayı hala önemini koruyan önemli bir hastalıktır. Bölgemizdeki immun trombositopenik purpura olgularını klinik özellikleri ve farklı tedavi metotlarına ve yaklaşımlarına verdikleri yanıtlar bakımından retrospektif olarak inceledik. Gereç ve Yöntem: Çalışmada akut ve kronik gidişli immün trombositopenik purpuralı olgular, iki yaş altı ve iki yaş üzerindeki olgular ilk başvuru semptomları, muayene bulguları ve almış oldukları tedavi seçeneklerine verdikleri yanıt bakımından karşılaştırıldı. Bulgular: Çalışmaya dahi edilen olguların 78 tanesi erkek, 73 tanesi kız, ortalama yaş 5,1±3,4/yıl ve %75 akut, %25 olgu kronik immun trombositopenik purpura tanısı ile izlenmişti. İki yaşından büyük olguların kronikleşmeye gidiş oranı, iki yaşından küçük gruba göre daha yüksek bulundu (p=0.01). Olgular en sık cilt bulguları ile hastaneye başvurmuş ve semptomları daha az belirgin olan olguların %64,6'sı kronikleşmişti. Mevsim ve cinsiyet faktörü akut-kronik immun trombositopenik purpura olmayı etkilemediği saptandı (p=0.119 ve p=0.061). İlk tedavide steroid alan ve tedavi sonunda parsiyel remisyon gerçekleşen hastalarının kronikleşme oranı (p=0.001) ve akut olguların steroide olumlu yanıt oranı yüksekti (p=0.04). Sonuç: Olgularımızın klinik özellikleri ülkemizdeki diğer bildirilmiş immun trombositopenik purpura olgularına paralellik göstermekte olup ekonomik ve etkili tedavi seçimlerinin hastalığa bağlı morbidite ve mortaliteyi önleyerek hasta prognozuna olumlu katkı sağlayacağı düşünülmektedir. Anahtar kelimeler: İTP; çocuk; tedavi.

Anahtar Kelimeler

• İTP; çocuk; tedavi.

Kaynakça

1. George JN, Woolf SH, Raskob GE, Wasser JS, Aledort LM, Ballem PJ et al. Idiopathic thrombocytopenic purpura: a practice guideline developed by explicit methods for the
2. American Society of Hematology. Blood 1996;88:3—40.
3. Nathan D.G, Orkin H.S, Ginsburg D. Look A.T. Acquired Platelet Defects.HaematoIogy of Infancy and Childhood, Sixth Edition. Saunders Co, Philadelphia 2003;1597—609.
4. Sutor AH, Harms A, Kaufmehl K. Acute immune thrombocytopenia (ITP) in childhood: retrospective and prospective survey in Germany. Semin Thromb Hemost 2001;27:253-67.
5. Anoop P.|mmune thrombocytopenic purpura: historical perspective, current status, recent advances and future directions. Indian Pediatr 2012;49:811—8.
6. Nugent DJ. Childhood immune thrombocytopenic purpura. Blood Rev. 2002;16:27—9.
7. Arceci R. J, Hann I. M,Smith O. P. Idiopathic Thrombocytopenic Purpura. Pediatric Hematology, Third Edition. Blackwell Publishing 2006;526-47.
8. Aslan D, Yetgin S. Immun Trombositopeni. Katkı Pediatri Dergisi 2002;23:343—57.

9. Donato H, Picon A, Martinez M, Rapetti MC, Rosso A, Gomez S et al. Demographic data, natural history, and prognostic factors of idiopathic thrombocytopenic purpura
10. Moser AM, Shalev H, Kapelushnik J. Anti—D exerts a very early response in childhood acute idiopathic thrombocytopenic purpura. Pediatr Hematol Oncol 2002;19:407—1 1.
11. Nugent DJ. Immune thrombocytopenic purpura of childhood. Hematology Am Soc Hematol Educ Program 2006:97-103.
12. Blanchette VS, Carcao M. Childhood acute immune thrombocytopenic purpura: 20 years later. Semin Thromb Hemost 2003;29:605—17.
13. Medeiros D, Buchanan GR. Major hemorrhage in children with idiopathic thrombocytopenic purpura: immediate response to therapy and long—term outcome. J Pediatr 1998;133:334-9.
14. Yetgin S, Olcay L, Ozsoylu S, Hiçsönmez G, Gürgey A,
15. Tuncer AM. Retrospective analysis of 78 children with
16. 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:e506—12.
17. Segel GB, Feig SA.Controversies in the diagnosis and
18. Rajantie J, Zeller B, Treutiger |, Rosthöj S et al. Vaccination associated thrombocytopenic purpura in children. Vaccine 2007;25:1838—40.
19. Çocuk ve Ergenlerde Primer ITP Tanısı ve Tedavisi. http://www.thd.org.tr/tthata/userfiIes/fiIe/IMM%C3%9CN %20TROMBOSITOPENI.pdf
20. BoIton—Maggs PH, Moon I. Assessment of UK practice for
21. management of acute childhood idiopathic
22. Vesely S, Buchanan GR, Cohen A, Raskob G, George J.Self— reported diagnostic and management strategies in childhood idiopathic thrombocytopenic purpura: results of a survey of practicing pediatric hematology/oncology specialists. J Pediatr Hematol Oncol 2000;22:55—61.
23. Rand ML, Wright JF. Virus—associated idiopathic thrombocytopenic purpura. Transfus Sci 1998;19:253—9.
24. Yapici F, Sönmez T.G, Arisoy ES. The distribution of intestinal parasites and their causative factors in children. Turkiye Parazitol Derg 2008;32:346—50.
25. Hazzan R, Mukamel M, Yacobovich J, Yaniv I, Tamary H. Risk factors for future development of systemic lupus erythematosus in children with idiopathic thrombocytopenic purpura. Pediatr Blood Cancer 2006;47:657—9.
26. Altintas A, Ozel A, Okur N, Okur N, Cil T, Pasa S et al. Prevalenceand clinical significance of elevated antinuclear antibody test in children and adult patients with idiopathic thrombocytopenic purpura. J Thromb Thrombolysis 2007;24:163—8.
27. Samuel H, Nardi M, Karpatkin M, Hart D, Belmont M, Karpatkin S. Differentiation of autoimmune thrombocytopenia from thrombocytopenia associated with immune complex disease: systemic lupus erythematosus, hepatitis—cirrhosis, and HIV—1 infection by platelet and serum immunological measurements. Br J Haematol 1999;105:1086—91 .
28. Imbach P, Kühne T, Müller D, Berchtold W, Zimmerman S, EIaIfy M et al. Childhood ITP: 12 months follow—up data from the prospective registry | of the Intercontinental Childhood ITP Study Group (ICIS). Pediatr Blood Cancer 2006;46:351-6.
29. Monto AS.EpidemioIogy of viral respiratory infections. Am J Med 2002;1 1214—12.
30. Rosthoj S, Nielsen S, Pedersen FK. Randomized trial comparing intravenous immunoglobulin with methylprednisolone pulse therapy in acute idiopathic thrombocytopenic purpura. Danish |.T.P. Study Group. Acta Paediatr1996;85:910-15.
31. Söker M, Yaramış A,Ece A,Haspolat K,Devecioğlu C. Akut immun trombositopenik purpuralı çocuklarda Anti—D ve immunglobulin—G tedavisinin karşılaştırılması. Dicle Tıp Dergisi 2001 ;83—92.
32. Fujisawa K, Iyori H, Ohkawa H, Konishi S, Bessho F, Shirahata A et al. A prospective, randomized trial of conventional, dose—accelerated corticosteroids and intravenous immunoglobulin in children with newly diagnosed idiopathic thrombocytopenic purpura. Int J Hematol 2000;72:376—83.
33. Başvuru Tarihi: 16.01.2013, Kabul Tarihi: 14.03.2013
34. Correspondence / İletişim 0 For citing/ Atıf için:
35. Feride ÇELİKER AKYÜZ
36. Diyarbakır Çocuk Hastanesi, Çocuk Sağlığı ve Hastalıkları, DİYARBAKIR TÜRKIYE
37. E—mail: feride©gmail.com
38. AkyUz FC, Kelekci S, Soker M, Karabel M, Sen V, Uzel VH,
39. Yolbaş I, Gunes A. Evaluation of immune thrombocytopenic
40. purpura cases: a single center experience. J Turgut Ozal
41. Med Cent 2013;20(3):246—251 DOI: 10.7247/jtomc.20.3.11