THE OUTCOME OF IMMUNE THROMBOCYTOPENIC PURPURA IN CHILDHOOD AND THE RISK FACTORS FOR CHRONICITY

Abstract

Objective: Immune thrombocytopenic purpura (ITP) is the most common cause of pediatric thrombocytopenia. It is usually a self-limiting disease; however, 20-30% of cases become chronic. In this study, we aimed to investigate pediatric ITP cases’ outcomes and whether there are any factors affecting chronicity. Methodology: We analyzed retrospectively our 184 newly diagnosed pediatric ITP cases. Thrombocytopenia was defined as chronic ITP if it persists after 12 months. We evaluated the role of clinical and laboratory findings of patients and treatment modalities in the chronicity of ITP. Results: The mean age of patients was 5.4 ± 4.75 years at diagnosis. As first-line treatment, 87 (47.3%) of patients were given Intravenous Immune Globulin, 65 (35.3%) of patients were given methylprednisolone, and 32 (17.4%) of patients were followed without any medication. Chronic ITP developed in 39 patients (21.1%). Chronic ITP development rate was 20.19% in boys and 22.5% in girls (p=0.7). While the chronicity rate was 7.02% in children younger than two years old and 17.81% in children between 2 and 6 years, it was 42.59% in children older than six years old (p<0.0001). Mean hemoglobin and absolute lymphocyte count were significantly lower in chronic ITP patients in the 2-6 years age group. (p=0.014 and p=0.048, respectively). The first-line treatment choice had no important effect on chronicity (p=0.61). Conclusion: Our results suggest that the most critical factor in developing chronic ITP was the age at diagnosis. Low lymphocyte counts at diagnosis may be associated with a high chronicity ratio.