면역 혈소판감소증 소아 환자에서 임상적 특징과 예후의 상관성

면역 혈소판감소증 소아 환자에서 임상적 특징과 예후의 상관성

Correlation of Clinical Features and Outcome in Children with Immune Thrombocytopenia

(구연):
Release Date : 2014. 10. 24(금)
Sung Jin Kim, Hyo Seop Ahn , Hyoung Soo Choi
Seoul National Univesity Bundang Hospital Department of Pediatrics1
김성진 , 안효섭 , 최형수
분당서울대학교병원 소아청소년과1

Abstract

Introduction: Immune thrombocytopenia (ITP) is the most common cause of abrupt onset thrombocytopenia in an otherwise healthy child. Many efforts have been made to identify patients at risk of developing persistent or chronic ITP. The aim of this research was to investigate the relationship of clinical features and outcome of patients receiving intravenous immunoglobulin (IVIG), with the intent of identifying prognostic factors. Methods: During the period between January 2009 and July 2014, we retrospectively analyzed 94 children newly diagnosed with ITP who received IVIG treatment. Medical records of all patients were reviewed retrospectively. CBCs with differential counts were obtained at diagnosis, 1, 3, 6, and 12 months. Results: Ninety four patients aged between 1.3 months and 15 years (median 27.3 months) were enrolled. Multivariate analysis showed that patient gender, age at diagnosis, history of viral infection or vaccination prior to disease onset and IVIG dosage was not statistically correlated with platelet recovery at 6 and 12 months. Also, hemoglobin count, total leukocyte count (TLC), absolute neutrophil count (ANC), and absolute lymphocyte count (ALC) at diagnosis was not correlated with patient outcome. However, early platelet count recovery of ≥ 100,000/μl at 1 and 3 months after IVIG treatment was significantly correlated with platelet recovery at 6 ( P 0.001 and P 0.001, respectively) and 12 months ( P = 0.014 and P = 0.019, respectively). Conclusion: To date, there is no consensus regarding the management of acute ITP, however IVIG use to expedite the recovery of a platelet count adequate for hemostasis is commonly practiced for newly diagnosed ITP children. The results of this study indicate that early platelet count recovery was the only significant prognostic factor associated with a short disease duration and favorable outcome. Further investigation of a larger pool of patients is warranted to validate these findings and an understanding of the pathophysiological mechanism underlying this association is needed to properly identify prognostic factors of patients at risk of developing persistent or chronic ITP. Disclosures: No relevant conflicts of interest to declare.

Keywords: immune thrombocytopenia (ITP), outcome, prognostic factors