Idiopathic thrombocytopenic purpura in childhood: a 10-year audit

Abstract

Objectives: To evaluate clinical course, treatment modalities, complications and referral pattern in paediatric patients treated over a 10-year period.Design: A retrospective, descriptive, hospital based study.Setting and subjects: 123 patients were diagnosed with ITP at Tygerberg Hospital from January 1996 to December 2006. Thirteen were excluded. The information of 106 patients was examined in detail.Outcome measures: Comparison of presenting platelet counts, special investigations, response and complications.Results: The mean age at presentation was 4·9 years (range 2 months – 13 years 3 months). A history of a preceding infection was obtained in 51% of patients. The mean presenting platelet count at diagnosis was 11·5 × 109/L (range 1 × 109 to 104 × 109/L). In 25 patients observation alone was the treatment choice. Specific treatment for ITP was given to 81 patients; steroids were used in 46 patients and intravenous immunoglobulin (IVIG) in seven patients. A combination of steroids and IVIG was used in 28 patients. There was no statistical difference in response to any therapy. Three patients developed an intracranial haemorrhage, two died. Twenty-one patients progressed to chronic ITP (19%). ITP had a benign clinical course with 87% of patients experiencing no major complication and 90% of patients making a complete recovery with or without treatment.Conclusion: ITP in South African children presents similarly to that in other settings, however the rate of intracranial haemorrhage was higher in this series than in literature. There were no statistically significant differences in the effects of various treatments, and observation alone was a successful treatment modality.