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Clinical Outcome and its Predictors in Children With Newly Diagnosed Immune Thrombocytopenia
Parameswary Singaravadivelu1, Jaikumar Govindaswamy Ramamoorthy2, C G Delhi Kumar1
1Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
Insights
Predictors for chronic and persistent immune thrombocytopenia (ITP) in children were studied. Higher absolute lymphocyte count (ALC) at admission was linked to better treatment response in pediatric ITP patients.
Area of Science:
- Pediatric Hematology
- Immunology
- Clinical Research
Background:
- Immune thrombocytopenia (ITP) is an autoimmune disorder characterized by low platelet counts.
- Predicting the chronicity of ITP in children is crucial for effective management.
- Understanding predictors for persistent ITP aids in early intervention strategies.
Purpose of the Study:
- To identify predictors for chronic and/or persistent immune thrombocytopenia (ITP) in newly diagnosed children.
- To analyze factors associated with treatment response in pediatric ITP.
Main Methods:
- A mixed-design study combining prospective (2020-2022) and retrospective (2014-2019) data.
- Enrollment of children aged 1 month to 18 years with newly diagnosed ITP.
- Follow-up of participants to assess disease persistence and response to treatment.
Main Results:
- 67.2% of children developed persistent ITP and 41.4% developed chronic ITP.
- Higher absolute lymphocyte count (ALC) at admission was associated with overall response at 3 and 12 months.
- Intracranial bleeding occurred in 6.25% of cases; chronicity and bleeding rates exceeded literature reports.
Conclusions:
- The incidence of chronic ITP and intracranial bleeding in this cohort was higher than previously reported.
- Elevated ALC at admission is a potential predictor of treatment response in pediatric ITP.
- Further research is needed to elucidate the specific mechanisms and refine management guidelines.
Objective:
To determine the predictors for chronic and/or persistent immune thrombocytopenia (ITP) among children with newly diagnosed ITP.
Methods:
Ours was a mixed-design study (prospective: January 2020 to March 2022 and retrospective: January 2014 to December 2019), wherein we enrolled children, aged 1 month to 18 years presenting with newly diagnosed ITP.
Results:
Of the 64 enrolled participants, 58 were followed up for atleast 1-year duration and 6 children were followed up for 3 to 12 months' duration. The median (IQR) age of the cohort was 8 (5, 11) years with a female preponderance (62.5%). Wet bleeding was seen in 56%; 6.25% developed intracranial bleeding. 67.2% (43/64) and 41.4% (24/58) children developed persistent and chronic ITP, respectively. Of the 34 children who achieved complete response at 12-months follow up, 21 (62%) achieved complete response by 3 months and the rest achieved complete response over the next 9 months. Development of overall response (complete or partial) at 3 and 12 months, was associated with a higher absolute lymphocyte count (ALC) at admission. The median ALC (×103/µL) at admission was 3.77 and 2.87 in children who had overall response and no response at 3 months, respectively (P = 0.03). The median ALC (×103/µL) at admission was 3.99 and 2.96 in children who had overall response and no response at 12 months, respectively (P = 0.04). Response rate was lesser in the treated group by approximately 10% compared to the non-treated group.
Conclusion:
The rate of chronicity and intracranial bleeding in our cohort is more than the reported rates in literature. Higher ALC was found to be associated with response.
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