RESULTS
One hundred-four of patients were male (56.5%) and 80 (45.5%) were female. The mean age of patients was 5.4 ± 4.75 years at diagnosis. All patients divided three study groups. Group 1: 0-2 years, group 2: 2,01-6 years, and group 3: 6,01-18 years. (Table 1)
The most common bleeding site was skin in 83,7%, followed by mucosal bleedings in 9 .7% of patients. Ten patients (5.4%) had no bleeding symptom and thrombocytopenia were detected when complete blood count has done due to other causes. None of the patients had a life-threatening condition such as central nervous system bleeding. Mean hemoglobin levels, total leukocyte count, absolute neutrophil count, absolute lymphocyte count, platelet count, and MPV levels were calculated and evaluated between three groups. (summarized Table 2)
No triggering cause could be identified in 92 (50%) of patients. The most common triggering factor was upper respiratory tract infection in 63 (34,2 %) of patients. Six (3.3%) patients had varicella and five (2.7%) patients had lower respiratory tract infections before the diagnosis of ITP. At the serologic tests, EBV VCA IgM was positive in four (2.2%) cases, CMV IgM was positive in two cases (1.1%) and rubella IgM was positive in two cases (1.1%). Three patients had a history of preceding rotavirus vaccination.
When patients evaluated according to first-line treatment options, 87 (47.3%) of patients were given IVIG, 65 (35.3%) patients were given methylprednisolone, and 32 (17.4%) patients were followed without any medication. Third and later treatment strategies were low dose-long term prednisolone treatment 10 (5.4%) patients, eltrombopag 7 (3.8%) patients, rituximab treatment five (2.7%) patients, splenectomy five (2.7%) patients, and mycophenolate mofetil two (1.1%) patients.
We saw a high level of difference between the age groups in the choice of treatment options. (p<0.0001) IVIg treatment option was used by especially in the infancy age group. (Table 1 and 3) The treatment modality at first admission was found to not affect the progression of chronic ITP (p=0.61). Besides, when we examined according to age groups, we did not observe any effect of the first choice of treatment in acute ITP patients on chronicity. (group 1 p: 0.4, group 2 p: 0.42, group 3 p: 0.33)
Some characteristics of the patient according to treatment modality were given in Table 1.
Thirty-nine patients (21.1%) who had persistent thrombocytopenia after 12 months of follow-up were accepted as chronic ITP.
The ratios of chronicity were 20.19% in males (21 in 104 patients) and 22.5% in females (18 in 80 patients). There was no difference between the genders in terms of chronicity in our patients (p: 0.7), and there was no difference between the genders when examined in the age groups.
The most important factor in the development of chronic ITP was the age at the initial diagnosis. The mean age at diagnosis was 4.54±4.18 years in acute ITP and 8.62±5.39 years in chronic ITP (p<0.0001). Acute and chronic ITP ratio was 53/4 for the patients younger than 2 years of age, 60/13 for the patients between 2 and 6 years of age, and 31/23 for over 6 years of age (p<0.0001). Also, we evaluated by the age groups; and we found statically significant high-level differences between three age groups. (p: 0.002) The rate of second-line treatment requirement and chronicity ratio according to age groups and treatment methods are given in Table 4.
The thrombocyte counts and mean platelet volume (MPV) at diagnosis did not affect chronicity in all patients. Besides, these values similar to all the age groups, and no differences between three age groups.
The thrombocyte counts and mean platelet volume (MPV) at diagnosis did not affect chronicity. Total leukocyte count at diagnosis had also no effect on chronicity, but mean absolute neutrophil count (ANC) was significantly higher (p=0.007) and mean absolute lymphocyte count (ALC) was significantly lower (p<0.0001) in chronic ITP patients. However, when these findings were re-evaluated by the age groups, it was concluded that the differences occurred based on ages. But when these findings were re-evaluated according to each age group, we did not find any important differences between acute and chronic cases for mean ANC and ALC, except only ALC levels were slightly lower in the chronic group in the 2nd age (2-6 years) group (p:0.031).
Mean hemoglobin levels, total leukocyte count, absolute neutrophil count, absolute lymphocyte count, platelet count, and MPV according to age groups and treatment methods are given in Table 2.
We did not see any effect on the chronicization of a cause such as infection or vaccination before acute ITP. Splenectomy was performed in five (2.7%) of chronic ITP patients.