Authors: N. Sharon
Published: 2019-06-17
DOI: 10.1097/01.hs9.0000567452.76736.c1
Source: Full article
Please indicate where the abstract has been published before: Journal of Pediatric Hematology OncologyBackground:Immune thrombocytopenia (ITP) of childhood is characterized by isolated thrombocytopenia (platelet count <100,000/μL, with a normal white blood cell count and normal hemoglobin levels). The cause of ITP remains unknown in most cases, but it can be triggered by a viral infection or other immunologic or environmental factors.1–3 The annual incidence of ITP in children is estimated to be between 1 and 6.4 cases per 100,000 children.3–5 Affected children are young (peak age, ∼5y) and previously healthy, and they typically present with the sudden onset of petechiae or purpura a few daysorweeksafteraviralinfection.Boysandgirlsareequally affected.6 Primary ITP is categorized into 3 phases, on the basis of the time period since diagnosis:1 (1) newly diagnosedITP: ITP within 3 months of diagnosis; (2) persistent ITP: ongoing ITP between 3 and 12 months of initial diagnosis; and (3)chronicITP:ITPlasting for >12 months ofdiagnosis.Immune thrombocytopenia (ITP) of childhood is characterized by isolated thrombocytopenia (platelet count <100,000/μL, with a normal white blood cell count and normal hemoglobin levels). The cause of ITP remains unknown in most cases, but it can be triggered by a viral infection or other immunologic or environmental factors.Aims:Our objective was to assess risk factors for developing chronic immune thrombocytopenia (ITP) in children.Methods:All categorical variables were presented by counts and percentages and compared using the χ2 test or the Fisher exact test. Continuous variables were presented by means ± SD and compared by the Mann‐Whitney test because of the non‐normal distribution. A logistic regression model with a backward elimination method wasapplied to identifythe factors that are related to the chronic state of the disease. Significance level was defined as α = 0.05. Analyses were carried out using SPSS version 24.0.Results:Sixty‐two children were included in the study (mean age, 6.15y); 44 (71%) were found to have acute ITP, and 18 (29%) developed chronic ITP (permanent or relapsing thrombocytopenia >12mo). In a univariate analysis, cutaneous hemorrhages were observed significantly more in acute patients (90.9%) than in chronic patients (61.1%). Patients who had acute ITP were more likely to present with a combination of petechiae, purpura, and/or ecchymosis (75%) than patients with chronic disease (44.4%, P = 0.010). In multivariate analysis, older age increased the risk (odds ratio = 1.1; P<0.05) for chronic disease, and manifestations of combination skin hemorrhages (petechiae/ purpura/ecchymosis) reduced the risk (odds ratio = 0.167; P<0.05).Summary/Conclusion:In conclusion, the most important risk factor for chronic disease is older age. Skin hemorrhage types were found to be a supportive factor for the prediction process: the combination of petechia/purpura/ecchymosis was associated with a lower risk for developing chronic disease compared with petechiae alone. Future studies should assess the prognostic value of skin hemorrhage types that are a simple way to predict the course of ITP in children