Abstract Number: PB1237
Meeting: ISTH 2020 Congress
Background: Immune thrombocytopenia (ITP) is a bleeding disorder characterized by increased platelet destruction and suboptimal platelet production resulting in thrombocytopenia. Childhood ITP usually resolves with or without intervention for most affected children while a certain number of children may progress to chronic illness.
Aims: To identify clinical characteristics of childhood ITP and risk factors for developing chronic disease and outcomes in children with ITP.
Methods: 340 children with ITP hospitalized in our institute between January 2014 and October 2018 were retrospectively analyzed.
Results: ITP occurred with equal frequency in boys(50.6%) and girls(49.4%).134(39.4%), 107(31.5%) and 99(29.1%) children were classified as newly diagnosed, persistent and chronic ITP respectively.The mean age at presentation was 8.70±4.36 years.The most frequent complaint were petechia(87.9%), ecchymosis(56.2%) and epistaxis(46.5%). One child died of fatal bleeding, the mortality rate in the cohort was 0.29%. Of the 198 newly diagnosed/persistent ITP patients for whom follow-up data were more than 12 months, 115(58.1%) progressed to chronic type. The remaining 83 obtained sustained response including one persistent ITP child underwent splenectomy 8 months after initial diagnosis. The mean age at diagnosis was significantly higher in chronic group(p=0.000). Spontaneous remission was achieved by 41.4% of non-splenectomized children with newly diagnosed/persistent ITP within 12 months from initiation of disease and by 30.4% of chronic patients at the last follow-up(October 2019). Females developed chronic ITP significantly more often (p=0.034). In multivariable regression analysis, the risk of chronicity was associated with age (OR=1.085, CI=1.002-1.175) and insidious onset of symptoms (OR=4.348, CI=2.154-8.777), inversely associated with platelet antibody (OR=0.491, CI=0.242-0.997), gender was not a risk factor (OR=0.744, CI=0.375-1.477).
Conclusions: Childhood ITP is a benign condition in most cases, with rare severe hemorrhage, low mortality and relatively high spontaneous remission rate.The relevant risk factors for chronicity included insidious onset of symptoms and age at presentation, platelet antibody might be a favor factor.
| characteristics | Newly diagnosed ITP | Persistent ITP | Chronic ITP | P values | sustained response group | chronic group | P values |
| girls | 47.8% | 53.3% | 47.5% | 0.627 | 42.7% | 57.4% | 0.042 |
| Age at diagnosis(mean±standard deviation) | 8.93±4.57 | 9.45±4.06 | 7.60±4.21 | 0.007 | 7.89±4.19 | 10.06±4.28 | 0.000 |
| platelet count at diagnosis, ×109/L (median, range) | 7.5(1~68) | 10.5（0~91） | 15（1~87） | 0.001 | 10(0~68) | 9(1~80) | 0.785 |
| preceding infection | 54.9% | 42.5% | 40.2% | 0.050 | 54.9% | 47.8% | 0.328 |
| insidious onset | 25.4% | 61% | 74% | 0.000 | 22% | 60.5% | 0.000 |
| platelet antibody | 41.7% | 23.5% | 26.1% | 0.007 | 44.4% | 26.7% | 0.015 |
| ANA | 55.1% | 43% | 46.9% | 0.164 | 47.4% | 48.7% | 0.860 |
| Mucosal bleeding | 56.7% | 54.2% | 64.6% | 0.284 | 51.2% | 54.8% | 0.621 |
[Demographic,clinical,and laboratory data of different types of pediatric ITP]
| characteristics | Sustained response group | Chronic group | P value | Odds ratio | CI |
| girls | 42.7% | 57.4% | 0.398 | 0.744 | (0.375-1.477) |
| age | 7.89±4.19 | 10.06±4.28 | 0.045 | 1.085 | (1.002-1.175) |
| insidious onset | 22% | 60.5% | 0.000 | 4.348 | (2.154-8.777) |
| platelet antibody | 44.4% | 26.7% | 0.049 | 0.491 | (0.242-0.997) |
[prognostic factors for chronic ITP]
To cite this abstract in AMA style:
Li R, Yang R. Retrospective Analysis of Characteristics and Outcomes of 340 Pediatric ITP Patients in One Center [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/retrospective-analysis-of-characteristics-and-outcomes-of-340-pediatric-itp-patients-in-one-center/. Accessed December 11, 2023.« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/retrospective-analysis-of-characteristics-and-outcomes-of-340-pediatric-itp-patients-in-one-center/