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Long-term follow-up study of children with chronic ITP
J Akatsuka1, K Fujisawa, N Ishidoya
1Department of Pediatrics, Daisan Hospital, Jikei University School of Medicine, Tokyo, Japan.
Insights
Children with chronic idiopathic thrombocytopenic purpura often experience long-term hematologic and immunologic issues, including persistent thrombocytopenia and various complications. Long-term follow-up reveals ongoing health concerns beyond initial treatment.
Area of Science:
- Pediatrics
- Hematology
- Immunology
Background:
- Chronic idiopathic thrombocytopenic purpura (ITP) affects children, necessitating long-term health monitoring.
- Understanding residual abnormalities and complications in ITP is crucial for patient management.
Purpose of the Study:
- To assess long-term hematologic, immunologic, and physical growth outcomes in children with chronic ITP.
- To identify the prevalence of residual symptoms and complications in a cohort of ITP patients over an extended period.
Main Methods:
- A long-term follow-up study involving 126 children with chronic ITP, including 35 splenectomized cases.
- Data collection included assessment of hematologic parameters, immunologic markers, physical growth, and patient-reported complications via questionnaire.
Main Results:
- Hemorrhagic symptoms persisted in 22%-28% of patients up to 15 years post-onset.
- Residual thrombocytopenia (<150,000/microliters) was observed in over 57% of patients across different long-term follow-up intervals.
- Other findings included mild anemia, altered immunoglobulin levels, positive autoimmune markers, and various complications like obesity and striae atrophicae.
Conclusions:
- Children with chronic ITP may experience persistent hematologic abnormalities and a range of complications years after diagnosis.
- Long-term monitoring is essential to manage residual effects and potential health issues in this pediatric population.
- Obesity was the primary observed physical growth disturbance, while other complications require continued attention.
Abstract:
A total of 126 children with chronic idiopathic thrombocytopenic purpura, including 35 splenectomized cases, were investigated in a long-term follow-up study, with regard to residual hematologic and immunologic abnormalities, complications and physical growth. Such hemorrhagic symptoms as petechiae, ecchymosis and epistaxis were still observed in about 22%-28% of the patients with a period of morbidity ranging from 3 to 15 years after onset. Residual thrombocytopenia below 150,000/microliters was found in 62% of patients within 5 years, 59% within 5 to 9 years and 57% within 10-14 years after onset. Other abnormalities were mild anemia, low serum level of IgA or IgM, positive antinuclear antibody, rheumatoid factor, and positive Coombs test in a small number of patients. Increased platelet-associated IgG was still obtained in patients with subnormal platelet counts whose morbid periods were 6 to 27 years after onset. Investigation of the patients by questionnaire revealed such complications as obesity, striae atrophicae, abdominal pain, headache, cataract, Perthes' disease, and cardiac complication in some patients. No apparent disturbances except for obesity were observed in their physical growth.