Clinical and laboratory predictors of chronic immune thrombocytopenia in children: A study of 25 cases and review of literature
Chronic immune thrombocytopenia in children
Background: Childhood immune thrombocytopenia (ITP) is a rare autoimmune bleeding disorder. Most children recover within 6 to 12 months, but individual course is difficult to predict. We performed a systematic review and meta-analysis to identify predictors of chronic ITP in 25 patients.
Methods and Material: Clinical and laboratory data of 50 cases of chronic ITP collected and analyzed to determine predictors of development of chronic ITP. We included observational cohort studies with newly diagnosed ITP patients studying the relationship among clinical, therapeutic, laboratory, or genetic parameters at time of diagnosis and development of chronic ITP after 1 year.
Result: Females developed chronic ITP significantly more often Patients who developed chronic ITP were older, and the mean difference was 2.68 Five articles studied the onset of disease and found significant more chronic ITP in patients with an insidious onset of ITP. The correlation between the absence of bleeding symptoms at diagnosis and a chronic course of ITP, and both did not find this to be a risk.
Discussion: There was acute and abrupt onset in our cases. The bleeding manifestations of thrombocytopenia were mucocutaneous petechiae, ecchymotic patches to hematuria and melena. Petechiae, purpura, and easy bruising are usually expected in ITP. Less common are epistaxis, gingival bleeding, and menorrhagia. Uncommon findings are melena, gross hematuria and intracranial hemorrhage. It is important to note that the clinical manifestations of thrombocytopenia vary with patient age. Older patients have more severe and rare bleeding manifestations, such as GI bleeding and possibly intracranial hemorrhage In children clinical manifestations are more mucocutaneous and usually self limiting.
Conclusion: The following are predictors of chronic ITP: female gender, older age at presentation (age ≥11 years, absence of preceding infection or vaccination, insidious onset, higher platelet counts at presentation ≥20 × 109/L, positive ANA titers and treatment with a combination of steroid and IVIg. Mucosal bleeding at diagnosis and treatment with IVIg seem to protect against development of chronic ITP.
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