Prognostic Evaluation For Immune Thrombocytopenia Outcome In Egyptian Children: A Retrospective Single Center Experience.

Objective: Immune thrombocytopenic purpura (ITP) is the most common cause of thrombocytopenia in children. This retrospective study was designed to Analyze presenting features of ITP cases in Benha, evaluate outcomes among children and Determine the prognostic factors like age, gender, residency, history of preceding vaccination and infection, complaint, initial platelet count and initial treatment modalities as guidelines for new cases at the time of diagnosis.

Method: Records of 308 children with ITP in Benha University Hospitals and Benha Children Hospital haematology clinics between May 2014 and January 2021 were retrospectively analyzed. Socio-demographic, clinical, and laboratory data of the studied children were recorded like age, gender, residence, date of diagnosis, complaint at presentation, preceding vaccination or infection, type of bleeding, initial platelet count, LDH(lactate dehydrogenase) level, initial treatment, and follow up of the disease.

Results: A total of 308 children diagnosed with ITP were included in our study, clinical courses were determined as acute and chronic in 71.4% and 28.6% respectively. The median age of patients on diagnosis was 5 ± 3.4 years. The male/female ratio was 1.14. Median age at diagnosis was significantly higher in chronic ITP (p<0.001), Patients with age ≥10 years developed chronicity more than younger cases (p=0.029). Regarding residency, seasonality, type of bleeding and history of preceding infection or vaccination, the difference was not statistically significant. Platelet count >20 ×10⁹ was significantly higher in chronic ITP(P<0.001). LDH level at presentation was significantly higher in chronic cases (p=0.046). Initial lines of treatment of patients admitted were steroids in 88%, IVIG in 5.2%, IVIG with steroids in 2.9% while 3.9% didn't receive any treatment, there was no significant difference in outcome between initial lines of treatment(P=0.105).

Conclusion: In our study, age >10 years, females, Initial high platelet count and high LDH level at presentation were found to increase the probability of chronic ITP.

Keywords: p

Objective: Immune thrombocytopenic purpura (ITP) is the most common cause of thrombocytopenia in children. This retrospective study was designed to Analyze presenting features of ITP cases in Benha, evaluate outcomes among children and Determine the prognostic factors like age, gender, residency, history of preceding vaccination and infection, complaint, initial platelet count and initial treatment modalities as guidelines for new cases at the time of diagnosis.

Method: Records of 308 children with ITP in Benha University Hospitals and Benha Children Hospital haematology clinics between May 2014 and January 2021 were retrospectively analyzed. Socio-demographic, clinical, and laboratory data of the studied children were recorded like age, gender, residence, date of diagnosis, complaint at presentation, preceding vaccination or infection, type of bleeding, initial platelet count, LDH(lactate dehydrogenase) level, initial treatment, and follow up of the disease.

Results: A total of 308 children diagnosed with ITP were included in our study, clinical courses were determined as acute and chronic in 71.4% and 28.6% respectively. The median age of patients on diagnosis was 5 ± 3.4 years. The male/female ratio was 1.14. Median age at diagnosis was significantly higher in chronic ITP (p<0.001), Patients with age ≥10 years developed chronicity more than younger cases (p=0.029). Regarding residency, seasonality, type of bleeding and history of preceding infection or vaccination, the difference was not statistically significant. Platelet count >20 ×10⁹ was significantly higher in chronic ITP(P<0.001). LDH level at presentation was significantly higher in chronic cases (p=0.046). Initial lines of treatment of patients admitted were steroids in 88%, IVIG in 5.2%, IVIG with steroids in 2.9% while 3.9% didn't receive any treatment, there was no significant difference in outcome between initial lines of treatment(P=0.105).

Conclusion: In our study, age >10 years, females, Initial high platelet count and high LDH level at presentation were found to increase the probability of chronic ITP.

Keywords: primary ITP, ITP outcome, ITP prognostic factors.

Abbervations: ITP : Immune thrombocytopenic purpura; LDH: lactate dehydrogenase

Abbervations: ITP : Immune thrombocytopenic purpura; LDH: lactate dehydrogenase

1. Abadi U, Yarchovsky-Dolberg O, Ellis MH. Immune thrombocytopenia: recent progress in pathophysiology and treatment. Clinical and Applied Thrombosis/Hemostasis. 2015 Jul;21(5):397-404.

2. Lanzkowsky P, editor. Manual of pediatric hematology and oncology. Elsevier; 2005 Jun. 4th ed; chapter 10, p: 250-259.

3. Imbach P, Kühne T, Müller D, Berchtold W, Zimmerman S, Elalfy M, et al. Childhood ITP: 12 months follow‐up data from the prospective registry I of the Intercontinental Childhood ITP Study Group (ICIS). Pediatric blood & cancer. 2006;46(3):351-6.

4. Rodeghiero F, Stasi R, Gernsheimer T, Michel M, Provan D, Arnold DM, et al. Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood. 2009 Mar 12;113(11):2386-93.

5. Provan D, Stasi R, Newland AC, Blanchette VS, Bolton-Maggs P, Bussel JB, et al. International consensus report on the investigation and management of primary immune thrombocytopenia. Blood. 2010 Jan 14;115(2):168-86.

6. Burness CB, Keating GM and Garnock-Jones KP. Eltrombopag: a review in paediatric chronic immune thrombocytopenia. Drugs. 2016 May;76(8):869-78.

7. Liang Y, Zhang L, Gao J, Hu D, Ai Y. Rituximab for children with immune thrombocytopenia: a systematic review. PloS one. 2012 May 30;7(5):e36698.

8. Makis A, Gkoutsias A, Palianopoulos T, Pappa E, Papapetrou E, Tsaousi C, et al. Prognostic factors for immune thrombocytopenia outcome in Greek children: A retrospective single-centered analysis. Advances in hematology. 2017 ; volume 2017, Article ID 7878605, 7 pages

9. Yong M, Schoonen WM, Li L, Kanas G, Coalson J, Mowat F, et al. Epidemiology of paediatric immune thrombocytopenia in the General Practice Research Database. British journal of haematology. 2010;149(6):855-64.

10. Saeidi S, Jaseb K, Asnafi AA, Rahim F, Pourmotahari F, Mardaniyan S, et al. Immune thrombocytopenic purpura in children and adults: a comparative retrospective study in IRAN. International journal of hematology-oncology and stem cell research. 2014;8(3):30.

11. Nazari SH, ABDOLLAH GF and SADEGHI KM. Epidemiology of idiopathic thrombocytopenic purpura in children. Iranian Journal of Pediatric Hematology Oncology. 2012 ; 2, (1): 35- 39.

12. AL-Zuhairy SH. Evaluation of prognostic factors in newly diagnosed childhood primary immune thrombocytopenia (ITP): two-year prospective study at Al-Sadder Hospital, Missan Province. Med J Babylon. 2013;10:855-69.

13. France EK, Glanz J, Xu S, Hambidge S, Yamasaki K, Black SB, et al. Risk of immune thrombocytopenic purpura after measles-mumps-rubella immunization in children. Pediatrics. 2008 Mar 1;121(3):e687-92.

14. SÖĞÜT G, LEBLEBİSATAN G, BARUTÇU A, KILINÇ Y, ŞAŞMAZ Hİ. Evaluation of Pediatric Patients with Immune Thrombocytopenia Regarding Clinical Course and Treatment Response: A Retrospective Single-Center Experience. Pediatric Practice and Research. 2020; 8(2):38-42.

15. Al‐Samkari H and Kuter DJ. Lactate dehydrogenase is elevated in immune thrombocytopenia and inversely correlates with platelet count. British journal of haematology. 2019 ;187(3):e61-4.

16. Grimaldi‐Bensouda L, Nordon C, Leblanc T, Abenhaim L, Allali S, Armari‐Alla C, et al. Childhood immune thrombocytopenia: A nationwide cohort study on condition management and outcomes. Pediatric blood & cancer. 2017 ;64(7):e26389.

17. Singh G, Bansal D and Wright NA. Immune thrombocytopenia in children: Consensus and controversies. The Indian Journal of Pediatrics. 2020;87(2):150-7.

18. Güngör T, Bilir ÖA, Çulha VK, Güngör A, Kara A, Azık FM, et al. Retrospective evaluation of children with immune thrombocytopenic purpura and factors contributing to chronicity. Pediatrics & Neonatology. 2019 ;60(4):411-6.

19. Donato H, Picón A, Martinez M, Rapetti MC, Rosso A, Gomez S, et al. Demographic data, natural history, and prognostic factors of idiopathic thrombocytopenic purpura in children: a multicentered study from Argentina. Pediatric blood & cancer. 2009;52(4):491-6.

20. Watts RG. Idiopathic thrombocytopenic purpura: a 10-year natural history study at the childrens hospital of alabama. Clinical pediatrics. 2004 ;43(8):691-702.

21. Bansal D, Bhamare TA, Trehan A, Ahluwalia J, Varma N, Marwaha RK. Outcome of chronic idiopathic thrombocytopenic purpura in children. Pediatric blood & cancer. 2010 ;54(3):403-7.

22. Akbayram S, Dogan M, Ustyol L, Akgun C, Peker E, Bilici S, et al. The clinical outcome of 260 pediatric ITP patients in one center. Clinical and Applied Thrombosis/Hemostasis. 2011 ;17(6):E30-5.