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Immune thrombocytopenic purpura in childhood: a Lebanese perspective
Myrna Moussalem1, Nabil Yassine
1Pediatric Hematology-Oncology Division, Saint Georges Hospital affiliated with Balamand University, Beirut, Lebanon. mirnamou@inco.com.lb
Insights
Immune thrombocytopenic purpura (ITP) is a common childhood condition. This study found ITP in Lebanese children is generally benign, with some seasonal patterns and potential links to vaccinations needing further research.
Area of Science:
- Pediatric Hematology
- Immunology
- Autoimmune Disorders
Background:
- Immune thrombocytopenic purpura (ITP) is the leading cause of thrombocytopenia in children.
- ITP results from antiplatelet antibody production.
- It frequently necessitates pediatric consultations.
Purpose of the Study:
- To review characteristics of pediatric ITP patients in Lebanon.
- To discuss specific features of this patient cohort.
Main Methods:
- Retrospective chart analysis of 40 pediatric ITP patients (1998-2001).
- Diagnosis confirmed by bone marrow aspirate in most cases.
- Data collected on patient demographics, preceding illnesses, seasonal incidence, immunization history, and treatment outcomes.
Main Results:
- Mean age was 56 months, with equal sex distribution.
- Fever preceded diagnosis in over half of patients; 42% occurred between January-March.
- 10% presented with epistaxis; 10% developed chronic ITP; no life-threatening hemorrhages occurred.
Conclusions:
- Childhood Immune thrombocytopenic purpura is typically a benign condition.
- Seasonal variations and post-vaccine ITP require further investigation in larger studies.
- Future optimal treatment strategies depend on better disease phenotype delineation.
Unlabelled:
Immune thrombocytopenic purpura (ITP), due to the production of antiplatelet antibodies, is the most prevalent etiology of thrombocytopenia in children and a frequent cause of consultation for the pediatrician. We review here a series of Lebanese pediatric patients presenting with ITP and we discuss the relevant characteristics of the group.
Study:
A retrospective chart analysis was performed for 40 hospitalized or out-patient children presenting with ITP between January 1998 and December 2001. All cases except two had a diagnosis confirmed by bone marrow aspirate. Patients were equally distributed between the sexes with a mean age of 56 months. More than half of the patients had an episode of fever 2 days to 8 weeks prior to the diagnosis. For 42% of them, the disease appeared in the months between January and March. Ten percent presented with epistaxis but all of these had a platelet count less than 12,000. One-third of the patients had received immunization 2-8 weeks before the diagnosis, with one patient having a relapse 4 weeks after mumps-measles-rubella (MMR) immunization, which was 1 year after the initial cure. Initial treatment consisted of either steroids or intravenous polyvalent immunoglobulin in 58 and 36% of the cases, respectively. None of the patients had life-threatening hemorrhage. Only 10% of the patients developed chronic ITP (unremitting after 6 months).
Conclusion:
ITP is generally a benign disease in infancy and childhood. Certain characteristics of ITP in this series, such as the seasonal variation and the post-vaccine ITP, will need to be better defined in larger prospective studies. Optimal treatment will eventually be targeted towards a better delineation of the disease phenotype.