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. 2014 Mar;31(1):32-9.
doi: 10.4274/Tjh.2012.0049. Epub 2014 Mar 5.

Childhood Immune Thrombocytopenia: Long-term Follow-up Data Evaluated by the Criteria of the International Working Group on Immune Thrombocytopenic Purpura

Melike Sezgin Evim  1 , Birol Baytan  1 , Adalet Meral Güneş  1
Affiliations

Childhood Immune Thrombocytopenia: Long-term Follow-up Data Evaluated by the Criteria of the International Working Group on Immune Thrombocytopenic Purpura

Melike Sezgin Evim et al. Turk J Haematol. 2014 Mar.

Abstract
in English, Turkish

Objective: Immune thrombocytopenia (ITP) is a common bleeding disorder in childhood, characterized by isolated thrombocytopenia. The International Working Group (IWG) on ITP recently published a consensus report about the standardization of terminology, definitions, and outcome criteria in ITP to overcome the difficulties in these areas.

Materials and methods: The records of patients were retrospectively collected from January 2000 to December 2009 to evaluate the data of children with ITP by using the new definitions of the IWG.

Results: The data of 201 children were included in the study. The median follow-up period was 22 months (range: 12-131 months). The median age and platelet count at presentation were 69 months (range: 7-208 months) and 19x10(9)/L (range: 1x10(9)/L to 93x10(9)/L), respectively. We found 2 risk factors for chronic course of ITP: female sex (OR=2.55, CI=1.31-4.95) and age being more than 10 years (OR=3.0, CI=1.5-5.98). Life-threatening bleeding occurred in 5% (n=9) of the patients. Splenectomy was required in 7 (3%) cases. When we excluded 2 splenectomized cases, complete remission at 1 year was achieved in 70% (n=139/199). The disease was resolved in 9 more children between 12 and 90 months.

Conclusion: Female sex and age above 10 years old significantly influenced chronicity. Therefore, long-term follow-up is necessary in these children.

Amaç: İmmün trombositopeni (ITP), izole trombositopeni ile karakterize çocukluk çağında yaygın görülen bir kanama hastalığıdır. Uluslar arası ITP çalışma grubu (IWG), zorlukların üstesinden gelmek için ITP’de terminolojinin, tanımların ve sürecin standardizasyonu hakkında bir uzlaşı raporu yayınlamıştır. Gereç ve Yöntemler: ITP’li hastalarımıza ait kayıtlar Ocak 2000’den Kasım 2009’a kadar, geriye yönelik olarak, IWG’nin yeni kriterleri kullanılarak değerlendirilmek üzere toplandı. Bulgular: İki yüz bir çocuğun verileri çalışmaya dahil edildi. Ortanca takip süresi 22 ay (12-131 ay) idi. Başvuru anında ortanca yaş ve trombosit sayısı, sırası ile 69 ay (7-208 ay) ve 19x109/L (1-93x109/L) idi. Hastalığın kronikleşmesi açısından iki risk faktörü saptadık: Kız cinsiyet (OR=2,55, CI=1,31-4,95) ve yaşın 10’dan büyük olması (OR=3,0, CI=1,5-5,98). Hayatı tehdit edici kanama, hastaların 5%’inde (n=9) görüldü. Splenektomi yapılması,7 hastada (3%) gerekti. İlk bir yılda splenektomi yapılan 2 hasta göz ardı edildiğinde, tam remisyon (CR) 70% (n=139/199) hastada görüldü. Hastalık, kronik ITP’li olguların 9’unda (%15; 9/60) daha tanıdan itibaren12 ile 90 ay içerisinde düzeldi.Sonuç: Kız cinsiyet ve yaşın 10’dan büyük olması, kronikleşmeyi belirgin olarak etkiledi. Ancak bu çocuklarda uzun sureli takip gereklidir.

Keywords: Long-term survival; Thrombocytopenia; children.

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Figures

Figure 1
Figure 1. The number of children with persistent versus chronic ITP according to sex.
Figure 2
Figure 2. The number of children with persistent versus chronic ITP according to different age groups at diagnosis. *Group 1: between ≥6 and ≤12 months, **Group 2: between >1 year and ≤10 years, ***Group 3: >10 years.
Figure 3
Figure 3. The rate of platelet recovery during 12 months of follow-up (excluding 2 splenectomized patients).
See this image and copyright information in PMC

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