PB2301: PEDIATRIC IMMUNE THROMBOCYTOPENIA; A GLANCE AT PATIENTS AND CURRENT THERAPEUTIC CHALLENGES

Abstract

Background: Immune thrombocytopenia (ITP) during childhood is usually characterized by acute onset of thrombocytopenia with around 75% of children having spontaneous remission within 6 months. Most children experience only mild bleeding in the form of bruising and Petechiae, with severe bleeding being rare even in children with persistent disease Aims: To study demography, clinical, laboratory and treatment options of patients who were newly registered cases of immune thrombocytopenia referred to Children Welfare Teaching Hospital, Medical City, Baghdad. Methods: A retro-prospective descriptive study was done on pediatric patients with ITP who were referred to Children’s Welfare Teaching Hospital (CWTH) / Medical City / Baghdad from January 1, 2020 to August 31, 2021. The period of data collection and follow up started in May 2020 till October 2021. Results: A total of 138 patients were identified as having a presumptive newly diagnosed Immune Thrombocytopenia. Sixteen patients were excluded after being diagnosed as secondary ITP or other causes of thrombocytopenia during observation period. The analysis was limited to 122 patients. The mean age was 4.75 years (range 2 months-13.1 years). There were 63 (51.6%) boys and 59 (48.4%) girls, with a M:F ratio was 1.06:1. The mean duration of symptoms is 13.6 days. Seventy-five (61.5%) patients were managed as an outpatient only. Sole cutaneous bleeding was reported in 57 (46.7%) patients while epistaxis was the leading cause of mucosal bleeding occur in 30 (25%) patients followed by gum bleeding in 15 (12.5%) patients. According to grading, grade I/II was seen in 57 (46.7%). The mean platelet count was 20.2x109/L, Platelet’s count of <30 x109/L in 95 (77.8%) patients. Ninety-three patients (76.2%) reached CWTH without receiving any treatment while 29 (23.8%) patients received treatment elsewhere. The total number of patients kept under watchful waiting strategy was 56 (45.9%). The mean and median platelets count at both time of diagnosis and time of last contact in the observation group were higher than that of the treatment group at time of diagnosis (26 vs 15.4 x 109/L) with a significant statistical correlation, and comparable at time of last follow up (200.7 vs 210.4 x 109/L) with negligible statistical correlation. There was a significant statistical correlation between both groups of patients in regard to the grades of bleeding, the observed group showed grade I\II as the major type of bleeding while the treated group showed grade III as the major type of bleeding. Summary/Conclusion: The result of this study confirms the result of two previous studies in the same center which encourages the successful management of ITP by observation only and support the consensus that ITP is a benign and self-limited condition for the majority of affected children. The incidence of intracranial bleeding was 0.8%. The study observations support the emerging trend toward reserving drug therapy for ITP patients with major bleeding manifestations or troublesome impairment of quality of life.