BACKGROUND: Idiopathic thrombocytopenia (ITP) is the most common bleeding
disorder in children, characterized by immune mediated platelets destruction.
Objective: The aim is to determine the clinical features, treatment and outcomes of
children with ITP.
PATIENTS AND METHODS:
The files of 165 pediatric patients diagnosed and treated between January 1997 and
September 2005 were retrospectively reviewed; data abstracted including age, gender,
presenting clinical features, laboratory findings and treatment outcome.
RESULTS:
They were 98 males and 67 females patients
(M:F) (1.5:1).The median age was 4 years and
6 months with a range between 1.5months -15
years. The most common presenting features
were purpura in 92.7%, epistaxis 37%, and
gum bleeding 17.5%.
One hundred fifteen (70%) of the patients had
platelets count less than 20.000/µl. One
hundred fifty one Patients (94%) were treated.
Steroids was given to 123 Patients with 89%
response rate (110 patients), 13 patients did not
respond to steroid therapy. Out of the 110
patient responded to steroid only 74 patient
thrombocytes count had sustained the response
to steroids. IVIG was given to 61 Patients.
Forty six patients (75%) had a good response
to IVIG but only 21 patients had a sustained
response. Combined treatment of steroid and
IVIG was given to 57 Patients, only 25 patients
(28%) had response and none of them had
sustained response. The 57patients had
combined therapy were; 29 had combined
steroid and IVIG from the start, while the other
28 patients were 13 patients who had steroid
and they did not respond, and the other 15
patients had IVIG only but did not showed
response. Nine patients had Splenectomy,
7patients (77.8%) responded and only two
patients did not show response.
One hundred fifty one (94%) Patients
recovered within 4-8 weeks, 43 (26%)
developed chronic ITP (persistent more than 6
months), nine children underwent splenectomy
and was curative in 7 patients. Nine Patients
recovered spontaneously, 11 patients have
persistent thrombocytopenia, and 13 patients
were lost follow up. Overall, 140 patients
(85%) of 165 children recovered completely.
CONCLUSION:
Acute and chronic ITP in children are
generally benign condition. Treatment
decisions should follow guide line based
on the clinical picture and platelets
count. Splenectomy should be
considered in chronic ITP with
significant bleeding and for patients did
not respond to medical treatment.
Key words
ITP in children, Splenectomy, Steroid, IVIG, Chronic ITP