Blood Res.  2016 Jun;51(2):95-101. 10.5045/br.2016.51.2.95.

Platelet count recovery after intravenous immunoglobulin predicts a favorable outcome in children with immune thrombocytopenia

• Choi HS
• Ji MH
• Kim SJ
• Ahn HS

• KMID: 2309210
• DOI: http://doi.org/10.5045/br.2016.51.2.95

Abstract

BACKGROUND
Childhood immune thrombocytopenic purpura (ITP) is a common acquired bleeding disorder. Even though most children recover, either spontaneously or with therapy, 10-20% of newly diagnosed ITP cases have a chronic course beyond 12 months. This study evaluated whether clinical and laboratory findings can predict the response to intravenous immunoglobulin (IVIG) and progression to persistent or chronic ITP in children.
METHODS
During the period between March 2003 and June 2015, we retrospectively analyzed 72 children, newly diagnosed with ITP, who received IVIG treatment. Peripheral blood counts were obtained at diagnosis and at 1, 3, 6, and 12 months after IVIG treatment.
RESULTS
After 6 months of IVIG treatment, 14 of 72 patients (19.4%) had persistent ITP, and after 12 months, 7 of 40 patients (17.5%) had chronic ITP. Age at diagnosis, gender, history of viral infection, or vaccination before disease onset were not statistically correlated with platelet recovery at 6 and 12 months. However, a platelet count recovery of ≥100×10(3)/µL at 1 and 3 months was significantly correlated with platelet recovery at 6 (P<0.001 and P<0.001, respectively) and 12 (P=0.007 and P=0.004, respectively) months.
CONCLUSION
This study demonstrated that early platelet count recovery, at 1 and 3 months after IVIG treatment, predicts a short disease duration and a favorable outcome in children with newly diagnosed ITP. Further investigation in a larger group of patients is warranted to validate these findings.

Keyword

Childhood; Immune thrombocytopenia; Intravenous immunoglobulin; Prognostic factor

MeSH Terms

Blood Platelets*
Child*
Diagnosis
Hemorrhage
Humans
Immunoglobulins*
Immunoglobulins, Intravenous
Platelet Count*
Purpura, Thrombocytopenic, Idiopathic*
Retrospective Studies
Vaccination
Immunoglobulins
Immunoglobulins, Intravenous

Figure

• 

  Fig. 1 Relationship between platelet counts at 1 month and recovery at 6 and 12 months after IVIG treatment. (A) Seventy-two patients were followed up at 6 months after the initial diagnosis of ITP and IVIG treatment. Among 15 patients with platelet <100×103/µL at 1 month after IVIG treatment, 6 patients (40%) had persistent ITP at 6 months, while 8 of 57 patients (14%) with platelet ≥100×103/µL at 1 month had persistent ITP at 6 months (P=0.003). (B) Forty patients were followed up at 12 months after the initial diagnosis and IVIG treatment. Among 14 patients with platelet <100×103/µL at 1 month of IVIG treatment, 5 patients (35.7%) had chronic ITP at 12 months, while only 2 of 26 patients (7.7%) with platelet ≥100×103/µL at 1 month had chronic ITP (P=0.039).

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