Clinical profile of ITP in Children: A single center study

Abstract

 BACKGROUND:  Idiopathic thrombocytopenia (ITP) is the most common bleeding disorder in children, characterized by immune mediated platelets destruction. Objective: The aim is to determine the clinical features, treatment and outcomes of children with ITP.  PATIENTS AND METHODS:  The files of 165 pediatric patients diagnosed and treated between January 1997 and September 2005 were retrospectively reviewed; data abstracted including age, gender, presenting clinical features, laboratory findings and treatment outcome. RESULTS:  They were 98 males and 67 females patients (M:F) (1.5:1).The median age was 4 years and 6 months with a range between 1.5months -15 years. The most common presenting features were purpura in 92.7%, epistaxis 37%, and gum bleeding 17.5%. One hundred fifteen (70%) of the patients had platelets count less than 20.000/µl. One hundred fifty one Patients (94%) were treated. Steroids was given to 123 Patients with 89% response rate (110 patients), 13 patients did not respond to steroid therapy. Out of the 110 patient responded to steroid only 74 patient thrombocytes count had sustained the response to steroids. IVIG was given to 61 Patients. Forty six patients (75%) had a good response to IVIG but only 21 patients had a sustained response. Combined treatment of steroid and IVIG was given to 57 Patients, only 25 patients (28%) had response and none of them had sustained response. The 57patients had combined therapy were; 29 had combined steroid and IVIG from the start, while the other 28 patients were 13 patients who had steroid and they did not respond, and the other 15 patients had IVIG only but did not showed response. Nine patients had Splenectomy, 7patients (77.8%) responded and only two patients did not show response.   One hundred fifty one (94%) Patients recovered within 4-8 weeks, 43 (26%) developed chronic ITP (persistent more than 6 months), nine children underwent splenectomy and was curative in 7 patients. Nine Patients recovered spontaneously, 11 patients have persistent thrombocytopenia, and 13 patients were lost follow up. Overall, 140 patients (85%) of 165 children recovered completely. CONCLUSION:  Acute and chronic ITP in children are generally benign condition. Treatment decisions should follow guide line based on the clinical picture and platelets count. Splenectomy should be considered in chronic ITP with significant bleeding and for patients did not respond to medical treatment.