Newly diagnosed immune thrombocytopenia in children and adults: a comparative prospective observational registry of the Intercontinental Cooperative Immune Thrombocytopenia Study Group

Abstract

BackgroundPrimary immune thrombocytopenia is a bleeding diathesis with an unknown etiology in predisposed individuals with immune disturbances. Although it is claimed that children and adults differ in clinical and laboratory aspects, few data exist to corroborate this observation. Our objective was to assess comparative data from children and adults with newly diagnosed immune thrombocytopenia. Design and MethodsClinical and laboratory data of 1,784 children and 340 adults were extracted from the Pediatric and Adult Registry on Chronic Immune Thrombocytopenia. The registry represents a prospective cohort of children and adults with newly diagnosed immune thrombocytopenia. Participating investigators registered their patients immediately after the diagnosis using a web based data transfer. Children aged under 16 years were compared with adults aged 16 years and over with descriptive statistical analyses. ResultsThe presenting mean platelet count of children and adults was 18.1 and 25.4¥10 9 /L. Signs of bleeding were reported in 24% of children and in 23% of adults, and intracranial hemorrhage in 10 of 1,784 children and in 6 of 340 adults. Co-morbidity was observed in 3.9% of children and in 30% of adults. Bone marrow aspiration and laboratory tests (antinuclear antibodies, human immunodeficiency and hepatitis C virus) were performed more frequently in adults. Children and adults were followed with a 'watch and wait' strategy in 20% and in 29%, respectively. Immunoglobulins were used more frequently in children and corticosteroids in adults. ConclusionsComparative data of children and adults with newly diagnosed immune thrombocytopenia revealed similarities in presenting platelet counts and in bleeding, whereas differences occurred in co-morbidity, diagnostic procedures and therapy.Key words: immune thrombocytopenia, newly diagnosed, similarities, differences, comparative data. Group. Haematologica 2011;96(12):1831-1837. doi:10.3324/haematol.2011 This is an open-access paper. Citation Newly diagnosed immune thrombocytopenia in children and adults: a comparative prospective observational registry of the Intercontinental Cooperative Immune Thrombocytopenia Study Group

Occult hemorrhage in children with severe ITP

“…Results are descriptive, including 95% exact confidence intervals. A one-sample proportion test compare the frequency of occult hemorrhage by site (urine, stool, CNS) with the incidence of overt hemorrhage in children with ITP reported in the literature [17][18][19][20] (Table I). The incidence of blood in the urine and stool reported in the literature for healthy children [21][22][23] was used as a comparison group.…”

Hospitalizations in pediatric patients with immune thrombocytopenia in the United States

“…While some studies characterize pediatric ITP as benign, describing major bleeding as rare [15][16][17][18], other studies have found major bleeding to be more common [19], with rates comparable with those seen in adults [20]. One analysis of 40 cases of ICH in children with ITP found a mortality rate of 25% with ICH and a reported incidence of ICH ranging from 0.19% to 0.78% [21]; other reports have also had varying incidence rates of ICH in pediatric ITP [11,13,20].…”

“…One analysis of 40 cases of ICH in children with ITP found a mortality rate of 25% with ICH and a reported incidence of ICH ranging from 0.19% to 0.78% [21]; other reports have also had varying incidence rates of ICH in pediatric ITP [11,13,20]. Regarding infection/sepsis, there are isolated reports of sepsis both with and without splenectomy [19,22]; the latter may coexist with unrecognized immunodeficiency.…”

Using a standardised protocol was effective in reducing hospitalisation and treatment use in children with newly diagnosed immune thrombocytopenia

“…Furthermore, while patients may be severely thrombocytopenic, they rarely present with severe bleeding. Therefore, ITP is usually recognised as a benign condition, with at least 75% of children having minor or no bleeding in spite of extremely low platelet counts (10,11). Nevertheless, severe haemorrhages, such as intractable epistaxis, gastrointestinal bleed or intracranial haemorrhages (ICH), may occur (12).…”