Fatigue in children and adolescents with immune thrombocytopenia

Abstract

Immune thrombocytopenia (ITP), an acquired autoimmune disorder of low platelets and risk of bleeding, has a substantial impact on health-related quality of life (HRQoL). Patients with ITP often report significant fatigue, although the pathophysiology of this is poorly understood. In this observational cohort of 120 children receiving second-line therapies for ITP, we assessed reports of fatigue using the Hockenberry Fatigue Scale. Children and adolescents with ITP reported a similarly high level of fatigue with 54% (29/54) of children and 62% (26/42) of adolescents reporting moderate-to-severe fatigue. There was no correlation between fatigue and age or gender. Adolescents with newly diagnosed and persistent ITP had higher mean fatigue scores than those with chronic ITP (P = 0Á03). Fatigue significantly improved in children and adolescents by 1 month after starting second-line treatments, and this improvement continued to be present at 12 months after starting treatment. Fatigue scores at all time-points correlated with general HRQoL using the Kids ITP Tool, but did not correlate with bleeding symptoms, platelet count, or platelet response to treatment. Fatigue is common in children and adolescents with ITP and may benefit from ITP-directed treatment even in the absence of bleeding symptoms.

Fatigue perception in a cohort of children with chronic immune thrombocytopenia and their caregivers using the PedsQL MFS: Real‐life multicenter experience of the Italian Association of Pediatric Hematology and Oncology (AIEOP)

“…Several factors including frequent hospitalizations, therapy side effects, limitations in social activities, iron deficiency from bleeding, and the perception of parental anxiety should be all considered as potential causes of poor HRQoL in children with ITP 15,22,41 . Our findings appear similar to those observed in adults affected by ITP, 31 and confirm earlier reports from pediatric studies 20,21 . Sarpatwari et al in a study conducted on 696 adults and 94 children with ITP showed that 12.5% and 8%, respectively, experienced fatigue.…”

“…Towner et al reported fatigue in 70% of pediatric patients affected by ITP 20 . Subsequently, Grace et al confirmed these results 21 . Our study quantitatively assesses fatigue in children with chronic ITP and their caregivers, using a validated, standardized, and age‐appropriate instrument.…”

“…Fatigue is a debilitating symptom in patients affected by ITP with a significant influence on HRQoL and mental health 21,31,36 . Despite the recognized effects of ITP on HRQoL in adults, 37–39 there is a scarcity of studies describing ITP impact on HRQoL in childhood.…”

“…To date, few studies have explored fatigue and its relationship with chronic ITP in children and adolescents 20,21 . The aim of the present study is to determine fatigue perception in a large group of children with chronic ITP and their caregivers using PedsQL MFS, and to compare the results with those of healthy control subjects.…”

“…In several studies, fatigue is reported as an important clinical and psychological aspect for a significant number of children and adults affected by ITP 19–21 . To date, causes of fatigue in patients with ITP are not fully understood.…”