INTRODUCTION
Immune thrombocytopenic purpura (ITP) is an autoimmune disease present
with isolated thrombocytopenia (thrombocyte count <
100.000/mm3), develops due to increased thrombocyte destruction by
autoantibodies, and its mostly benign, and self-limited disease. (1) The
peak incidence is seen between two and 5-years of age and in 60%-80%
of patients, it resolves with remission within 12 months. (2)
The incidence of ITP was reported as 7.2-9.5/100.000 per year in North
America, whereas European studies reported the incidence as
2.9-5.3/100.000. (2, 4) To avoid terminological conflict in definition,
the first 3 months of diagnosis is defined as “newly diagnosed ITP”,
three to 12 months of disease is defined as “persistent ITP” and the
disease persist over 12 months of duration is defined as “chronic
ITP”.(5)
ITP pathophysiology is a very complex condition. The accused factors in
ITP pathogenesis are Ab-mediated (etc. against to GPIIb-GPIIIa,
GPIb-GPIX) destruction, impaired megakaryopoiesis (Ab and/or cellular
destruction, slightly elevated TPO), elevated Tcell activity.(2) These
Ab’s can be oligoclonal or polyclonal, and different subclass IgG
families. (6)
Corticosteroids and intravenous immunoglobulin (IVIG), anti Rh D immune
globulin (only Rh-positive patients) are commonly used in the treatment
of ITP in children as first-line treatment options.(7-9)
The second line treatment options are anti-Rhesus-D immunoglobulin,
immunosuppressive agents (azathioprine, cyclosporine, sirolimus,
mycophenolate mofetil), anti-CD20 (rituximab), and several
chemotherapeutics (iphosphamide, vinca alkaloids) or combinations of
these options.(10, 11) Recently refractory cases are treated with
thrombopoietin (TPO) receptor agonists (romiplostim, eltrombopag) and
they are licensed in the treatment of ITP. (12-14)
Chronicity factors for pediatric ITP; advanced age, insidious beginning,
highly (especially > 20.000/mm3) platelet
numbers, and female gender.(15)
In this study, we aimed to determine the main characteristics and
outcomes of our pediatric ITP cases and whether there are any risk
factors affecting chronicity.