Retrospective Evaluation of Chronic Idiopathic Thrombocytopenia in Libyan Children

Main Article Content

Haloom Abdel Salam Elhashmi
Ainour Ibrahim Abdulhamid

Abstract

Immune thrombocytopenic purpura (ITP) is the most common cause of acquired thrombocytopenia in children. Approximately 10-20% of children with Immune thrombocytopenia (ITP) suffer from a chronic clinical disease that requires follow up and medical intervention according to the severity of bleeding manifestation.

Aims: To evaluate the demographic, clinical, and laboratory features, treatment modalities, and response to therapy in Libyan children with chronic idiopathic thrombocytopenia.

Methods: A retrospective study was conducted at the hematology clinic of the pediatric department, Benghazi medical center, and Benghazi Children Hospital. The duration of the study was from January 1998 to December 2018. comprised of demographics, clinical, laboratory data, therapy and therapy response in Libyan chronic ITP.

Results: In our study, the mean age of chronic ITP patients was 4.9 years, slightly higher in male patients 43 (52.4%) With a male/female ratio 1.1:1. The most frequent symptoms were mild   which were limited to bruises and petechiae on the skin. (57.3%). The preceding history of viral infection was uncommon in patients with chronic ITP (22%) while the past history of MMR vaccination is quite rare and constituted only (2%). The mean platelet count before treatment (i.e. at presentation) was (22.7x109/L) while mean platelet count after treatment (213.6 x109/L. Treatment consisted of combined Steroid + IVIG in 27 (77.1% response), steroids in 23 (73.9% response), intravenous immunoglobulin (IVIG) in 11 (90.9% response), and no therapy in 21 (95.2% response).Complete response was achieved in 82.9% % showed a complete response either spontaneous or following the treatment. No patient was presented with intracranial hemorrhage.

Conclusions: Chronic ITP in Libyan children had a benign nature, none of our patients developed severe symptoms as life-threatening bleeding like CNS bleeding or died, IVIG give more optimistic response as compare to steroid. And the majority of children with chronic ITP in this study achieved remission.

Keywords:
Childhood, clinical profile, chronic, primary immune thrombocytopenia.

Article Details

How to Cite
Elhashmi, H. A. S., & Abdulhamid, A. I. (2021). Retrospective Evaluation of Chronic Idiopathic Thrombocytopenia in Libyan Children. Asian Journal of Research in Medical and Pharmaceutical Sciences, 10(1), 13-21. https://doi.org/10.9734/ajrimps/2021/v10i130154
Section
Original Research Article

References

Abadi U, Yarchovsky-Dolberg O, Ellis MH. Immune thrombocytopenia: recent progress in pathophysiology and treatment. Clinical and Applied Thrombosis/Hemostasis. 2015;21(5):397-404.

Rodeghiero F, Stasi R, Gernsheimer T, Michel M, Provan D, Arnold DM, Bussel JB, Cines DB, Chong BH, Cooper N, Godeau B. 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.

Harrington WJ, Minnich V, Hollingsworth JW, Moore CV. Demonstration of a thrombocytopenic factor in the blood of patients with thrombocytopenic purpura. The Journal of Laboratory and Clinical Medicine. 1951;38(1):1-0.

Bolton-Maggs PH, Moon I. Assessment of UK practice for management of acute childhood idiopathic thrombocytopenic purpura against published guidelines. The Lancet. 1997;350(9078):620-3.

Arnold DM. Bleeding complications in immune thrombocytopenia. Hematology 2014, the American Society of Hematology Education Program Book. 2015; 2015(1):237-42.

ITP A. Guidelines for the investigation and management of idiopathic thrombocytopenic purpura in adults, children and in pregnancy. Br J Haematol. 2003;120(1):574-96.

Donato H, Picón A, Rapetti MC, Rosso A, Schvartzman G, Drozdowski C, Di Santo JJ. Splenectomy and spontaneous remission in children with chronic idiopathic thrombocytopenic purpura. Pediatric Blood & Cancer. 2006; 47(S5):737-9.

Ramenghi U, Amendola G, Farinasso L, Giordano P, Loffredo G, Nobili B, Perrotta S, Russo G, Zecca M. Splenectomy in children with chronic ITP: Long‐term efficacy and relation between its outcome and responses to previous treatments. Pediatric Blood & Cancer. 2006; 47(S5):742-5.

Psaila B, Bussel JB. Refractory immune thrombocytopenic purpura: current strategies for investigation and management. British Journal of Haematology. 2008;143(1):16-26.

Neunert C, Lim W, Crowther M, Cohen A, Solberg L, Crowther MA. The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia. Blood. 2011;117(16): 4190-207.

Saleh MN, Gutheil J, Moore M, Bunch PW, Butler J, Kunkel L, Grillo-López AJ, LoBuglio AF. A pilot study of the anti-CD20 monoclonal antibody rituximab in patients with refractory immune thrombocytopenia. In Seminars in Oncology. 2000;27(6): Suppl 12:99-103.

Franchini M, Zaffanello M, Veneri D, Lippi G. Rituximab for the treatment of childhood chronic idiopathic thrombocytopenic purpura and hemophilia with inhibitors. Pediatric Blood & Cancer. 2007;49(1):6-10.

Liebman HA, Pullarkat V. Diagnosis and management of immune thrombocytopenia in the era of thrombopoietin mimetics. Hematology 2010, the American Society of Hematology Education Program Book. 2011(1):384-90.

Bussel JB, Buchanan GR, Nugent DJ, Gnarra DJ, Bomgaars LR, Blanchette VS, Wang YM, Nie K, Jun S. A randomized, double-blind study of romiplostim to determine its safety and efficacy in children with immune thrombocytopenia. Blood, The Journal of the American Society of Hematology. 2011; 118(1):28-36.

Neunert C, Terrell DR, Arnold DM, Buchanan G, Cines DB, Cooper N, Cuker A, Despotovic JM, George JN, Grace RF, Kühne T. American Society of Hematology 2019 guidelines for immune thrombocytopenia. Blood Advances. 2019; 3(23):3829-66.

Rosthøj S, Rajantie J, Treutiger I, Zeller B, Tedgård U, Henter JI, NOPHO ITP Working Group. Duration and morbidity of chronic immune thrombocytopenic purpura in children: five‐year follow‐up of a Nordic cohort. Acta Paediatrica. 2012 Jul; 101(7):761-6.

Tait RC, Evans DI. Late spontaneous recovery of chronic thrombocytopenia. Archives of Disease in Childhood. 1993; 68(5):680-1.

Kühne T, Imbach P, Bolton-Maggs PH, Berchtold W, Blanchette V, Buchanan GR, Intercontinental Childhood ITP Study Group. Newly diagnosed idiopathic thrombocytopenic purpura in childhood: an observational study. The Lancet. 2001 Dec 22; 358(9299):2122-5.

Ahmed S, Siddiqui AK, Shahid RK, Kimpo M, Sison CP, Hoffman MA. Prognostic variables in newly diagnosed childhood immune thrombocytopenia. American Journal of Hematology. 2004;77(4):358-62.

Kühne T, Berchtold W, Van Be T, Van Binh T, Imbach P. Ethnicity and environment may affect the phenotype of immune thrombocytopenic purpura in children. Pediatric Research. 2000;48(3): 374-9.

Zhao H, Li H, Zhang L, Wang T, Ji L, Yang R. Retrospective analysis of 472 Chinese children with chronic idiopathic thrombocytopenic purpura: A single center experience. Haematologica. 2005; 90(6):860-1.

Roganovic J, Letica‐Crepulja M. Idiopathic thrombocytopenic purpura: A 15‐year natural history study at the Children's Hospital Rijeka, Croatia. Pediatric Blood & Cancer. 2006;47(S5):662-4.

Yaprak I, Atabay B, Durak İ, Türker M, Öniz H, Özer EA. Variant clinical courses in children with immune thrombocytopenic purpura: sixteen year experience of a single medical center. Turkish Journal of Hematology. 2010; 27(3):147-55.

Wong MS, Chan GC, Ha SY, Lau YL. Clinical characteristics of chronic idiopathic thrombocytopenia in Chinese children. Journal of Pediatric Hematology/Oncology. 2002; 24(8):648-52.

Watts RG. Idiopathic thrombocytopenic purpura: a 10-year natural history study at the childrens hospital of alabama. Clinical Pediatrics. 2004; 43(8):691-702.

Moussalem M, Yassine N. Immune thrombocytopenic purpura in childhood: a Lebanese perspective. Molecular Immunology. 2003;39(17-18):1105-7.

Al-Mulla N, Bener A, Amer A, Laban MA. Idiopathic thrombocytopenic purpura in childhood: a population-based study in Qatar. Jornal de Pediatria. 2009; 85(3):269-72.

ElAlfy M, Farid S, Maksoud AA. Predictors of chronic idiopathic thrombocytopenic purpura. Pediatric Blood & Cancer. 2010; 54(7):959-62.

Fan QX, Wang CM, Chen SX, Liu XG, Han B. Immune Thrombocytopenic Purpura in Children of Eastern Henan Province, China. Indian Pediatrics. 2016;53(11).

Aronis S, Platokouki H, Mitsika A, Haidas S, Constantopoulos A. Seventeen Years of Experience with Chronic Idlopathlc Thrombocytopenic Purpura in Childhood. Is Therapy Always Better?. Pediatric Hematology and Oncology. 1994;11(5): 487-98.

Sabhan AH, Al-Jadiry MF, Ghali HH, Abed WM, Al-Hadad SA. Chronic immune thrombocytopenic purpura in children overview of 60 patients. Pediatric Hematology Oncology Journal. 2016; 1(1):9-12.

Glanz J, France E, Xu S, Hayes T, Hambidge S. A population-based, multisite cohort study of the predictors of chronic idiopathic thrombocytopenic purpura in children. Pediatrics. 2008;121(3):e506-12.

Elalfy M, Elbarbary N, Khaddah N, Abdelwahab M, El Rashidy F, Hassab H, Al-Tonbary Y. Intracranial hemorrhage in acute and chronic childhood immune thrombocytopenic purpura over a ten-year period: an Egyptian multicenter study. Acta Haematologica. 2010;123(1):59-63.

Wali YA, Lamki ZA, Shah W, Zacharia M, Hassan A. Pulsed high-dose dexamethasone therapy in children with chronic idiopathic thrombocytopenic purpura. Pediatric Hematology and Oncology. 2002;19(5):329-35.

Trad O, Alissa A, Baroudi M, El Hayek M. Diagnosis and treatment of idiopathic thrombocytopenic purpura: The Tawam hospital experience. Journal of Applied Hematology. 2011; 2(2):194.

Trabelsi M, Zeougha R, Dallagi K, Khaldi F, Bennaceur B. Idiopathic thrombocytopenic purpura in children. Apropos of 98 cases. Pediatrie. 1988; 43(1):67-72.