MATERIAL AND METHOD
In this retrospective study, we analyzed 184 children between 3 months
to 18 years of age who had newly diagnosed ITP, in Marmara University
Training and Research Hospital, Pediatric Hematology Unit, between
01.01.2012 and 12.31.2017.
Data including patient and disease characteristics such as age, sex,
presenting symptoms at the initial diagnosis, and findings in physical
examination, treatment modality, and outcome were collected in standard
forms for each patient. Hematologic data including initial complete
blood count, analysis of peripheral blood smears, and bone marrow
aspiration slides were all noted.
ITP was diagnosed in a child when platelet count under 100.000/µL with
normal hemoglobin and white blood cell count and there is no other
clinical and laboratory abnormality.
Only the patients who had platelet counts under 50.000/µL were admitted
to this study because most children with platelets count between 50,000
and 100,000/µL do not apply to the hospital or do not need treatment.
The patients who had other causes of thrombocytopenia (bone marrow
failure, malignancy, primary thrombocytopenia’s, infections, etc.),
maternal ITP, and patients without regular follow-up are excluded from
the study.
The patients were treated if they had a platelet count lower than
10.000/µL, or if they had wide-spread petechia, purpura, or bleeding
symptoms.
As first-line treatment, 87 (47.3%)of patients were given Intravenous
Immune Globulin ( IVIG, 1 g/kg, 1 or 2 days), 65 (35.3%) were given
methylprednisolone (20 mg/kg/day for three days, and 10 mg/kg/day for
four days), and 32 (17.4%) of patients were followed without any
medication.
In children who were given methylprednisolone treatment (MP), bone
marrow aspirations were done before starting treatment with MP. Although
bone marrow examination is not recommended for every patient in current
ITP guides, bone marrow examination was performed before treatment in
patients who will take steroids due to routine application in our
hospital during the study period.
Thrombocytopenia persisting beyond 12 months was defined as “chronic
ITP” whereas resolved thrombocytopenia within 12 months of diagnosis
was defined as ‘’acute ITP”. The
patients were divided into three age groups. Group I include the
patients younger (smaller) than 2 years of age (57 patients), group 2
include the patients between 2 and 6 years of age (73 patients), and
group 3 include the patients older (greater) than 6 years of age (54
patients).
The data of patients were analyzed using the IBM SPSS for Windows
version 20.0 (SPSS, Chicago, IL, USA). The data were expressed as mean ±
standard deviation (SD). The Shapiro–Wilk and Kolmogorov-Simirnov tests
were used for normality analysis of the data. If the skewness and
kurtosis range between to -1,5 and +1,5, we accepted the data was
normality. The unpaired Student t-test was used for
comparison of normal parameters of
acute and chronic ITP patients at diagnosis. Mann-Whitney U test was
used for comparison of non-normal differenced parameters of acute and
chronic ITP patients at diagnosis. The unpaired Student t-test was used
for comparison of mean age, mean hemoglobin level, mean platelet count,
mean total leukocyte count, mean absolute neutrophil count (ANC), and
mean absolute lymphocyte count (ALC) of acute and chronic ITP patients
at diagnosis. Intergroup rate comparisons were performed with Pearson
chi-square and Fisher’s exact tests.
The confidence level of 95% and p values of < 0.05 were
considered as statistically significant.