Hypovitaminosis D Influences the Clinical Presentation of Immune Thrombocytopenia in Children with Newly Diagnosed Disease

Abstract

Immune thrombocytopenia (ITP) is an acquired autoimmune disorder characterized by isolated thrombocytopenia defined as platelet count in peripheral blood <100 × 109/L. Hypovitaminosis D is very common in children with autoimmune diseases. To analyze whether hypovitaminosis D is associated with the clinical presentation of ITP in children, medical records of 45 pediatric patients with newly diagnosed immune thrombocytopenia in the coastal region of Croatia were evaluated. The severity of bleeding was assessed using two bleeding scores. Children with lower 25-hydroxyvitamin D (25(OH)D) values had higher values of the skin-mucosa-organ-gradation (SMOG) bleeding score and respectively more severe bleeding on diagnosis of ITP. With further analysis of the main domains of that score, we found that patients with a lower 25(OH)D value had more severe bleeding in the skin and organs. When 25(OH)D and ITP Bleeding Scale (IBLS) score were analyzed, a negative correlation was found, but it was not significant. Our findings suggest that hypovitaminosis D influences the severity of the clinical presentation of ITP in children on initial diagnosis of the disease. Therefore, therapy with 25(OH)D could be a new potential option for treatment of ITP. To investigate the connection between 25(OH)D and the incidence and severity of ITP, further studies, especially randomized controlled studies, are needed.

Recombinant Thrombopoietin Effectively Shortens the Time to Response and Increases Platelet Counts in Elderly Patients with Severe Immune Thrombocytopenia

“…As a glycosylated, full-length molecule, which is identical to endogenous TPO, the mechanism of rhTPO is more similar to that of natural TPO, and rhTPO shows profound effects on megakaryocyte development and platelet production. Previous studies have suggested that rhTPO markedly increases platelet counts in patients with chemotherapy-induced thrombocytopenia [ 16 ] as well as in patients with myelodysplastic syndromes and aplastic anemia [ 17 , 18 ]. Wang et al conducted a multicenter randomized controlled trial in 2012, showing that platelet counts in patients with chronic ITP increase rapidly after rhTPO treatment [ 19 ].…”

The Use of Clinical Scores in the Management of Immune Thrombocytopenic Purpura in Children

“…While investigations into immune functions in ITP ( 7 , 8 ), aiming for a better prediction of platelet count responses have been exploited and included in nowadays ITP management ( 9 – 11 ), a lack of consensus among clinical scores and use in ITP monitoring still exists ( 10 ). Several clinical scores have been developed including a combination of different already known risk factors: age, gender, presence of a previous infections or vaccination, bleeding grade, type of onset, platelet count at diagnosis ( 1 , 12 – 16 ).…”

Risk Factors and Psychological Analysis of Chronic Immune Thrombocytopenia in Children

“…Childhood immune thrombocytopenia is an acquired autoimmune disease characterized by a decrease in platelet count (<100×10 9 /L) and an increased risk of bleeding. 1,2 This thrombocytopenia may be due to reduced platelet production and immune-mediated destruction, but usually involves glycoprotein autoantibodies expressed on megakaryocytes. [3][4][5] ITP is the most common hemorrhagic disease in children, accounting for one-third of hemorrhagic diseases, 6 Its onset is usually acute and short-lived, with an incidence of approximately (2~5)/10 million.…”

“…Measurement data were expressed as mean±standard deviation (±s). The χ2 test was used to analyze the factors affecting the chronicity and effectiveness of ITP. Logistic regression analysis was performed on the age of onset, the course of first diagnosis and the first diagnosis of ALC.…”