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.