Platelets level response after three days therapy in children with acute Immune Thrombocytopenic Purpura (ITP): a 10 yearsâ€™ experience at the tertiary hospital

Ketut Ariawati; I Made Karma Setiyawan

doi:10.15562/bmj.v8i3.1558

Platelets level response after three days therapy in children with acute Immune Thrombocytopenic Purpura (ITP): a 10 yearsâ€™ experience at the tertiary hospital

Ketut Ariawati ,

I Made Karma Setiyawan ,

PDF |
DOI: https://doi.org/10.15562/bmj.v8i3.1558 |
Published: 2019-12-01

Abstract

Background: Immune thrombocytopenic purpura (ITP) is the most common cause of thrombocytopenia in children that characterized by isolated thrombocytopenia that vary in bleeding manifestations. The onset of disease is sudden and a self-limiting condition that requires treatment when clinically significant bleed occurs. A treatment goal is to increase platelet level above safety level and reduce the risk of severe bleeding. This study aims to evaluate the platelets level increment after three days treatment among children with acute ITP.

Methods: An analytic retrospective cross-sectional study was conducted in Haematology-Oncology Paediatric Division Sanglah General Hospital, Bali, Indonesia from October 2008 to October 2018 in ITP patients. Diagnosis of ITP was evaluated based on the clinical manifestation and laboratory finding. Oral corticosteroid medication with dosage 2 mg/kg/day or 4 mg/kg/day with or without platelets transfusion were enrolled in this study from medical records. Data were analyzed using SPSS version 20 for Windows.

Results: There were 93 children met the inclusion criteria and included in this study. A median platelets level at admission was 6.81(1-86.8) x 10⁹/L. Majority symptoms of children with ITP in our tertiary care centre presented with mild to moderate clinical bleeding symptoms. Only 5.6% children with platelets level below 10x10⁹/L had intracranial bleeding. Median platelets level was 31(2.47-382) x 10⁹/l and there was a significant platelets level increment after three days of therapy (P<0.05).

Conclusion: The platelets level increment significantly in children with acute ITP after three days of therapy.

References

Neunert C, Lim W, Crowther M, Cohen, Solberg L Jr, Crowther MA, et al. The American Society of Hematology evidence-based practice guideline for immune thrombocytopenia. Blood. 2011;117(16):4190-207.
Zafar H, Anwar S, Faizan M, Riaz S. Clinical features and outcome in paediatric newly diagnosed immune thrombocytopenic purpura in a tertiary care centre. Pak J Med Sci. 2008;34(5):1195-9.
Rodeghiero F, Stasi R, Gernsheimer T, Michel M, Provan D, Arnold DM, et al. Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood. 2009;113(11):2386-93.
Faki Osman ME. Childhood immune thrombocytopenia: clinical presentation and management. Sudan J Paediatr. 2012;12(1):27-39
Provan D, Stasi R, Newland AC, Blanchette VS, Bolton-Maggs P, Bussel JB, et al. International consensus report on the investigation and management of primary immune thrombocytopenia. Blood. 2010;115(2):168-96.
Krishnan R, Faisal M, Merlin TS, Oommen C. An update on the management of immune thrombocytopenic purpura and emerging treatment options: A review and case report. Int J Pharmacol Res. 2016;6(7):264-70.
Lanzkowsky P. Manual of pediatric hematology and oncology. 5th ed. London: Elsevier; 2011:321-77.
Naz A, Mukry SN, Shaikh MR, Bukhari AR, Shamsi TS. Importance of immature platelet fraction as predictor of immune thrombocytopenic purpura. Pak J Med Sci. 2016;32(3):575-9.
Khan AM, Mydra H, Nevarez A. Clinical practice updates in the management of immune thrombocytopenia. P T. 2017;42(12):756-63.
Parodi E, Giordano P, Rivetti E, Giraudo MT, Ansaldi G, Davitto M, et al. Efficacy of combined intravenous immunoglobulin and steroids in children with primary immune thrombocytopenia and persistent bleeding symptoms. Blood Transfus. 2014;12(3):340-5.
Saeidi S, Jaseb K, Asnafi AA, Rahim F, Pourmotahari F, Mardaniyan S, et al. Immune thrombocytopenic purpura in children and aduts: a comparative retrospective study in Iran. Int J Hematol Oncol Stem Cell Res. 2014;8(3):30-6.
Neunert CE. Management of newly diagnosed immune thrombocytopenia: can we change outcomes? Hematology Am Soc Hematol Educ Program. 2017;2017(1):400-405.
Psaila B, Petrovic A, Page LK, Menell J, Schonholz M, Bussel JB. Intracranial hemorrhage (ICH) in children with immune thrombocytopenia (ITP): study of 40 cases. Blood. 2009;114(23):4777-83.
Bennet CM, Neunert C, Grace RF, Buchanan G, Imbach P, Vesely SK, et al. Predictors of remission in children with newly diagnosed immune thrombocytopenia: data from the Intercontinental Cooperative ITP Study Group Registry II participants. Pediatr Blood Cancer. 2018;65(1):1-7
Raj AB. Immune thrombocytopenia: pathogenesis and treatment approaches. J Hematol Transfus. 2017;5(1):1-9.
Carcao MD, Zipursky A, Butchart S, Leaker M, Blanchette VS. Short-course oral prednisone therapy in children presenting with acute immune thrombocytopenia purpura (ITP). Acta Paediatr Suppl. 1998;424:71-4.
Jayaraman A, Das S, Biswal N, Dillikumar CG, Bade BA. High dose, short course prednisolone for acute idiopathic thrombocytopenic purpura (ITP) in children. International Journal of Contemporary Pediatrics. 2017;4(5):1705-8.
Sutor AH, Harms A, Kaufmehl A. Acute thrombocytopenia (ITP) in childhood: retrospective and prospective survey in Germany. Semin Thromb Hemost. 2001;27(3):243 -67.
Donato H, Picon A, Martinez M, Rapetti MC, Rosso A, Gomez S, et al. Demographic data, natural history, and prognostic factors of idiopathic thrombocytopenic purpura in children: a multicentered study from Argentina. Pediatr Blood Cancer. 2009;52(4):491-6.