การศึกษาย้อนหลัง 12 ปีของโรค Immune Thrombocytopenic Purpura (ITP) ในสถาบันสุขภาพเด็กแห่งชาติมหาราชินี
Keywords:
Immune thrombocytopenic purpura (ITP), ChildhoodAbstract
Abstract: Immune Thrombocytopenic purpura (ITP) is one of the most common hematologic diseases in children. Although majority of them recover within 6 months, some had chronic ITP. Objective: To evaluate natural history, clinical features, response to therapy, outcome and risk factors to develop chronic ITP. Materials and Methods: Charts of patients suspected of ITP were retrospectively retrieved and reviewed. Clinical features and treatment outcome of ITP patients. Using Cox proportional hazard model to determine risk factors to develop chronic ITP. Results: Of 342 patients diagnosed of ITP included in the analysis, 167 (49%) were males and 175 (51%) were females. Median age was 3.7 years (IQR 1.6 to 6.3 years). Median duration of symptoms prior to the hospital presentation was 7 days (IQR 3 to 30 days). No patient had CNS bleeding at initial diagnosis, and the platelet count was not correlated with severity of bleeding (p = 0.22). Initial treatment consisted of prednisolone (286; 84%), intravenous immunoglobulin (IVIG) (4; 1%) and no treatment (52; 15%). Recovery (platelet increased more than 150,000/mL) was found in 289 (85%) patients, and 210 (61%) recovered within 6 months. Median time to recovery was 36 days. Multivariable analyses identified that only age and duration of symptoms were associated with time to platelet recovery. Patients with a one year increase of age had a 5% decreased chance of platelet recovery. (Hazard Ratio [HR] 0.95; 95% CI 0.92 to 0.99, p = 0.01) and patients with duration of symptoms between 1 to 2 weeks, between 2 to 4 weeks, between 4 to 24 weeks and longer than 24 weeks had a 18%, 51%, 53% and 65% decreased chance of platelet recovery, respectively (p < 0.001). Treatment was not associated with the recovery. Death was found in 2 patients who died of severe sepsis from other causes. Conclusion : Childhood ITP is a common problem with low mortality rate. Most of the patients had spontaneous resolved independent to the treatment received. Older age and longer duration of symptoms are associated with failure to recovery, which leads to chronic ITP.
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