Secondary immune thrombocytopenia in children: Characteristics and outcome of a large cohort from two Spanish centres

Abstract

Aim: To evaluate the incidence and outcome of secondary immune thrombocytopenia (ITP) in a large cohort of paediatric Spanish patients. Methods: A retrospective observational study was conducted in two paediatricUniversity hospitals in Spain between 2009 and 2019, which included children from 4 months to 18 years old diagnosed with ITP. Data were recorded from clinical charts: gender, age at diagnosis, coexisting condition and associated characteristics, outcome and treatment.Results: Secondary ITP was diagnosed in 87 out of 442 patients (19.6%). Postimmunisation ITP was seen in younger children. The onset of secondary ITP to autoimmune diseases (AD) and immunodeficiencies (ID) was at an older age and had more tendency to be insidious, and platelet level was higher than primary ITP. Mean time from ITP onset to AD diseases or ID diagnosis was 1.2 and 2.6 years, respectively. Whereas the cumulative incidence of remission was significantly higher in postimmunisation and post-viral infection (compared with primary ITP patients), it was worse in AD and ID patients.Conclusions: Identification of secondary ITP is important as it predicts outcome. Most of them are diagnosed at ITP onset, but AD diseases and ID should be ruled out periodically as they are usually identified later.

Impact of Helicobacter pylori Infection upon the Evolution and Outcome of Pediatric Immune Thrombocytopenic Purpura: A Comprehensive Review

“…One study conducted on a numerous cohort of pediatric ITP patients, identified that the two most frequent causes of secondary ITP cases are recent immunizations and viral infections, followed by autoimmune disorders and immunodeficiency [16]. Within this study, post-immunization and post-viral infections ITPs showed the best remission rates [16]. Although H. pylori infection is usually acquired during childhood, physicians are less familiar with its extra-gastric, hematological manifestations.…”

“…In children in particular, search for a secondary cause of ITP and treatment of possible causative agents could represent an important therapeutic aid which can lead to avoidance of standard treatment and its widely known side effects, which are more extensive at this particular age group [68]. One study conducted on a numerous cohort of pediatric ITP patients, identified that the two most frequent causes of secondary ITP cases are recent immunizations and viral infections, followed by autoimmune disorders and immunodeficiency [16]. Within this study, post-immunization and post-viral infections ITPs showed the best remission rates [16].…”

“…Primary ITP accounts for 80-90% of adult cases [3,15]. In similar fashion, around 20% of children cases can be attributed to secondary causes, according to a Spanish study [16]. H. pylori has been regarded as one of the potential causes of secondary ITP, but it is yet unclear whether treatment of this particular infection might be sufficient to improve platelet numbers [17,18].…”

The effect of antinuclear antibody titre and its variation on outcomes in children with primary immune thrombocytopenia

“…Moreover, children diagnosed with primary ITP may, in the future, develop to autoimmune disease (AID) or haematological disease, such as systemic lupus erythematosus (SLE) and aplastic anaemia (AA). 8,[11][12][13][14] Studies on the development of diseases in children with primary ITP are limited. A prospective study conducted by Schifferli et al reported that among 13 (13/44, 29.5%) children with positive ANA,…”