Evaluation of clinical course, laboratory findings and treatment response in childhood immune thrombocytopenic purpura in Gaziantep

Objective: Immune thrombocytopenic purpura (ITP) is a common disease in children that can be seen in two clinical forms as acute and chronic. In our study, history, examination, laboratory findings, clinical course and treatment responses of patients with childhood ITP were evaluated in terms of determining causes of disease and the factors affecting the chronicity.Materials and Methods: The files of 103 patients followed as ITP and sufficient information can be accessed between March 2006 and February 2011 at Gaziantep University Faculty of Medicine, Department of Pediatric Hematology were investigated for history, clinical examination, laboratory findings, clinical course and treatment responses.Results: Average age at diagnosis was 73.0 ± 50.7 months and Female/Male ratio was 1.1. 34% of the patients had a history of previous infection and 3.9% had a history of vaccination. Rash and/or bruising (75.7%) and epistaxis (35.9%) were the most common complaints at admission. The patients were admitted mostly in spring (29.1%) and summer (27.2%). In patients, 33.3% had pozitive viral-bacterial serology, 20.6% cases had positive antinuclear antibodies (ANA), 29% had positive antithyroglobulin antibody (ATA). 50.5% of patients admitted during the acute phase were diagnosed as acute, 49.5% were diagnosed as chronic ITP. Chronicity was significantly higher in these groups whose age of diagnosis is >10 years, admission platelet count is >10.000/mm3, with insidious onset, and without a history of previous infection, (p=0.009, p=0.004, p<0.0001, p=0.0003). There was no difference in terms of the acute response and relapse ratios between the initial treatments with intravenous immunoglobulin (IVIG) and high-dose methylprednisolone (HDMP) (p=0.09, p=0.62, respectively). Between IVIG, HDMP and follow-up without treatment there was no difference in terms of chronicity (p=0.33).Conclusion: In children, ITP can be seen after previous infection or vaccination and may be associated with underlying autoimmune diseases. Although the prognose is variable, age at diagnosis, platelet count, the initiation and no previous infection history are risk factors for chronicity.Keywords: Child, Chronicity, ITP, Treatment.