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Chronic idiopathic thrombocytopenic purpura: incidence, treatment, and outcome
1Department of Haematology, Royal Victoria Infirmary, Newcastle upon Tyne.
Insights
Chronic idiopathic thrombocytopenic purpura (ITP) in children has a low incidence and generally benign outcome. Most children recover spontaneously, suggesting a less interventionist management approach.
Area of Science:
- Pediatric Hematology
- Immunology
- Clinical Epidemiology
Background:
- Chronic idiopathic thrombocytopenic purpura (ITP) is a bleeding disorder affecting children.
- Understanding ITP's natural history and management trends is crucial for optimal patient care.
Purpose of the Study:
- To determine the incidence, outcome, and management trends of chronic ITP in children.
- To analyze the natural history and long-term prognosis of pediatric chronic ITP.
Main Methods:
- Retrospective analysis of 92 children diagnosed with chronic ITP.
- Data compiled from a single center (1950-1980) and a population-based cohort (1984-1994).
- Incidence calculated from population-based data; treatment outcomes and spontaneous recovery rates assessed.
Main Results:
- The incidence of pediatric chronic ITP is 0.46 per 10(5) children per year.
- Splenectomy achieved remission in 85% of cases, with short initial histories predicting response.
- Spontaneous recovery occurred in most patients not treated with or responding to splenectomy, with a predicted 15-year remission rate of 61%.
Conclusions:
- Chronic ITP in children has a low incidence and a generally favorable prognosis.
- High rates of spontaneous remission suggest a less interventionist approach to management may be appropriate.
- Splenectomy remains effective but is offered less frequently, with no deaths directly attributed to chronic ITP in the study cohort.
Abstract:
In order to determine incidence, outcome, trends in management and natural history, data on 92 children with chronic idiopathic thrombocytopenic purpura (ITP), comprising 66 from a single centre's experience between 1950 and 1980 and all 26 presenting from a defined population between 1984 and 1994, have been analysed. Its incidence, calculated from the population based group, is 0.46/10(5) children per year. Twenty nine of 34 (85%) remitted after splenectomy. Short initial histories predicted response to splenectomy. Splenectomy was offered only half as frequently in the last 10 years as in the 30 year, single centre group of children. Most (39 cases) of those not offered or successfully treated by splenectomy recovered spontaneously. The predicted spontaneous remission rate in 85 with adequate follow up data is 61% after 15 years. No other form of active treatment was of lasting benefit. No death solely attributable to chronic ITP occurred. The high spontaneous recovery rate, low mortality, and generally benign outcome may encourage a less interventionist approach to management.
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