|
Indian Pediatr 2016;53: 1024-1025 |
|
|
Immune Thrombocytopenic Purpura in Children
of Eastern Henan Province, China
|
*Qiu-Xia Fan, #Chun-Mei Wang, $Shu-Xia
Chen, Xin-Guang Liu and Bo Han
Departments of the First People’s Hospital of Shangqiu
City, Shangqiu, #Pediatrics, the First Affiliated
Hospital of Zhengzhou University, Zhengzhou,and $Hematology,
the First People’s Hospital of Shangqiu City, Shangqiu,
China.
Email:
[email protected]
|
In this retrospective cohort study
conducted in 63 children with idiopathic thrombocytopenic purpura (ITP)
in China; petechiae, bruises and bleeding were the major presentations.
Most cases required therapy with one/more treatment options.
Keywords: Clinical profile, Thrombocytopenia,
Treatment
|
Immune thrombocytopenic purpura
(ITP) is an acquired autoimmune hematologic condition characterized by
destruction of platelets leading to isolated thrombocytopenia [1,2]. It
is customarily a self-limiting ailment in otherwise healthy children
presenting with bruising, purpura, petechiae, mucosal bleeding, and
thromvocytopenia, plasma anti-platelet antibodies, and rise in
megakaryocytes [3-5].
This retrospective study was performed in the
pediatric ward and outpatient clinic of a tertiary hospital in eastern
Henan province, China over a period of five years (August 2009 to
September 2014) to describe clinical features in children with ITP. The
study target population included children below 18 years’ age diagnosed
with ITP [as per International Statistical Classification of Diseases
and Related Health Problems 10th Revision (ICD-10) 2010 D69.3] and
treated at the hospital. A questionnaire was used for collection of
clinical and demographic data of the children based on medical
(hospital/clinic) records. Information on prescription drugs to patients
and treatment outcome were collected. The diagnosis was based on
clinical history as well as physical examination~ along with tests
revealing isolated thrombocytopenia (platelet count <100×10 9/L),
normal peripheral blood smear, white blood cells, and no underlying
malignancies and conditions. Details on bone marrow examination if
carried out were also collected. Chronic ITP was defined as persistent
thrombocytopenia, lasting greater than six months after the initial
diagnosis. The study got the approval from the institutional Ethics
Committee.
Of the 63 children studied, 73% were diagnosed with
acute ITP and 27% with chronic ITP. Acute ITP and chronic ITP were more
prevalent in boys (52.2% and 58.8%, respectively) compared to girls
(47.8% and 41.2%, respectively), though insignificant. Nearly 20.6% of
children had family history of ITP (Table I). Bone marrow
aspiration was performed in 36 (57.1%) cases to exclude other pathology;
all of which confirmed the diagnosis. No significant seasonal difference
was noted. History of preceeding viral infection was frequent in
relation to both acute and chronic ITP (73.9% and 64.7%). The most
widely used treatment for children was intravenous immunoglobulin (IVIG)
(61.9%) followed by steroids+IVIG (15.9%), anti-Rh(D) immunoglobulin
(9.5%), rituximab and splenectomy (1.6% each).
TABLE I Sociodemographic Characteristics, Clinical and Pathological Features of Children with ITP (N=63)
Characteristics |
ITP |
P value |
|
Total (n=63) |
Acute (n=46) |
Chronic (n=17) |
|
Age, yrs |
Mean (SD) |
4.2 (3.7) |
4.3 (3.8) |
4.0 (3.6) |
0.45 |
Median (Range) |
3 (0.4-16.2) |
3 (0.4-16.2) |
3.2 (0.7-15.5) |
|
Gender |
Male, n (%) |
34 (53.9) |
24 (52.2) |
10 (58.8) |
0.85 |
Family history of ITP |
13 (20.6) |
9 (19.6) |
4 (23.5) |
0.73 |
Abrupt onset (<1 week), n (%) |
47 (74.6) |
38 (82.6) |
9 (52.9) |
0.02 |
Clinical signs, n (%)
|
Petechiae
|
54 (85.7) |
39 (84.8) |
15 (88.2) |
1.00 |
Bruising |
46 (73.0) |
35 (76.1) |
11 (64.7) |
0.52 |
Bleeding |
23 (36.5) |
16 (34.8) |
7 (4.2) |
0.86 |
Epistaxis |
15 (23.8) |
11 (23.9) |
4 (23.5) |
1.00 |
Lymphadenopathy |
7 (11.1) |
7 (15.2) |
0 (0) |
0.17 |
Gastrointestinal bleed |
4 (6.4) |
3 (6.5) |
1 (5.9) |
|
Splenomegaly |
3 (4.8) |
1 (2.2) |
2 (11.8) |
0.17 |
Hepatomegaly |
3 (4.8) |
1 (2.2) |
2 (11.8) |
0.17 |
Treatment, n (%) |
IVIG |
39 (61.9) |
29 (63.0) |
10 (58.8) |
0.99 |
Steroid + IVIG |
10 (15.9) |
6 (13.0) |
4 (23.5) |
0.44 |
Anti-Rh(D) immunoglobulin |
6 (9.5) |
4 (8.7) |
2 (11.8) |
0.66 |
Rituximab |
1 (1.6) |
0 (0) |
1 (5.9) |
0.27 |
Splenectomy |
1 (1.6) |
1 (2.2) |
0 (0) |
1.00 |
Only observation |
6 (9.5) |
6 (13.0) |
0 (0) |
0.18 |
ITP = Immune thrombocytopenia purpura; IVIG = Intravenous
immunoglobulin. |
The treatment of ITP in different parts of the world
varies with respect to criteria for initiation of treatment, which
treatment modality to be used, and whether or not hospitalization is
required [6]. Limitations of present study included information bias as
well as selection bias, and restricted number of patients. We were
unable to evaluate all variables and were restricted by the in
completeness of proper documentation.
Although ITP is self-limiting in most of the cases,
it tends to be troublesome diagnosis for physicians and parents.
Petechiae, bruises and bleeding were the most common presentations in
children with ITP in present study. Most of cases of ITP needed
treatment with one/more of the available options. The overall prognosis
was found to be good.
References
1. Rodeghiero F, Stasi R, Gernsheimer T, Michel M,
Provan D, Arnold DM, et al. Standardization of terminology,
definitions and outcome criteria in immune thrombo-cytopenic purpura of
adults and children: Report from an international working group. Blood.
2009;113:23-86.
2. D’Orazio JA, Neely J, Farhoudi N. ITP in children:
Pathophysiology and current treatment approaches. J Pediatr Hematol
Oncol. 2013;35:1.
3. Nugent DJ. Immune thrombocytopenic purpura of
childhood. Hematol Am Soc Hematol Educ Program. 2006;97-103.
4. Rehman A. Acute immune thrombocytopenic purpura in
children. Turk J Hematol. 2007;24:41-51.
5. Cines DB, Blanchette VS. Immune thrombocytopenic
purpura. N Engl J Med. 2002;346:995-1008.
6. British committee for standard in Hematology
general Hematology Task force guidelines for the investigation and
management of idiopathic thrombocytopenic purpura (ITP) in adults,
children and in pregnancy. Br J Haematol. 2003;120:574-96.1.00.
|
|
|
|