A cross-sectional retrospective study to analyze the underlying causes and clinical characteristics of children with reactive thrombocytosis at a Korean tertiary medical center

Juhee Shin; Dong Hyun Lee; Nani Jung; Hee Joung Choi; Ye Jee Shim

doi:10.5045/br.2018.53.3.233

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Original Article

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Blood Res 2018; 53(3):

Published online September 28, 2018

https://doi.org/10.5045/br.2018.53.3.233

A cross-sectional retrospective study to analyze the underlying causes and clinical characteristics of children with reactive thrombocytosis at a Korean tertiary medical center

Juhee Shin, Dong Hyun Lee, Nani Jung, Hee Joung Choi, and Ye Jee Shim^*

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Department of Pediatrics, Keimyung University School of Medicine and Dongsan Medical Center, Daegu, Korea.

Correspondence to : Correspondence to Ye Jee Shim, M.D., Ph.D. Department of Pediatrics, Keimyung University School of Medicine, Dongsan Medical Center, Dalseong-ro 56, Jung-gu, Daegu 41931, Korea. yejeeshim@dsmc.or.kr

Received: April 2, 2018; Revised: June 4, 2018; Accepted: June 26, 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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Abstract

Background

Reactive thrombocytosis (RT) is a common condition among children, although no studies have examined the etiology or clinical characteristics of RT among Korean children.

Methods

This retrospective study evaluated children with RT at a single Korean tertiary center during a 10-year period.

Results

RT accounted for 13.5% of children who were admitted to the pediatric ward (4,113/30,355): mild RT, 82.7%; moderate RT, 14.1%; severe RT, 1.1%; and extreme RT, 2.1%. There was a negative correlation between platelet count and Hb level (P=0.008). There were positive correlations between platelet count and WBC (P=0.001), erythrocyte sedimentation rate (ESR) (P=0.007), and admission duration (P=0.006). The most common cause of RT was infection and the second most common was Kawasaki disease (KD). The highest proportion of lower respiratory tract infection was observed in extreme RT (P<0.001). The proportion of KD was highest in extreme RT (P<0.001) and in children aged 1–7.9 years (P<0.001). The proportion of refractory KD was highest in extreme RT (P=0.005). In cases of KD, there was a positive correlation between platelet count and fever duration (P=0.006). Non-KD autoimmune inflammation was only observed in mild/moderate RT, and its proportion was highest in children aged 8–18 years (P<0.001).

Conclusion

In children, more severe RT was associated with lower Hb, increased WBC, ESR, and prolonged admission. With respiratory infection or KD, extreme RT was associated with more severe disease course.

Keywords Reactive thrombocytosis, Extreme thrombocytosis, Children, Etiology, Kawasaki disease

Article

Original Article

Blood Res 2018; 53(3): 233-239

Published online September 28, 2018 https://doi.org/10.5045/br.2018.53.3.233

A cross-sectional retrospective study to analyze the underlying causes and clinical characteristics of children with reactive thrombocytosis at a Korean tertiary medical center

Juhee Shin, Dong Hyun Lee, Nani Jung, Hee Joung Choi, and Ye Jee Shim^*

Department of Pediatrics, Keimyung University School of Medicine and Dongsan Medical Center, Daegu, Korea.

Correspondence to: Correspondence to Ye Jee Shim, M.D., Ph.D. Department of Pediatrics, Keimyung University School of Medicine, Dongsan Medical Center, Dalseong-ro 56, Jung-gu, Daegu 41931, Korea. yejeeshim@dsmc.or.kr

Received: April 2, 2018; Revised: June 4, 2018; Accepted: June 26, 2018

Abstract

Background

Reactive thrombocytosis (RT) is a common condition among children, although no studies have examined the etiology or clinical characteristics of RT among Korean children.

Methods

This retrospective study evaluated children with RT at a single Korean tertiary center during a 10-year period.

Results

Conclusion

In children, more severe RT was associated with lower Hb, increased WBC, ESR, and prolonged admission. With respiratory infection or KD, extreme RT was associated with more severe disease course.

Keywords: Reactive thrombocytosis, Extreme thrombocytosis, Children, Etiology, Kawasaki disease

Abstract

Fig 1.

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Figure 1.

Correlation analysis revealed a negative correlation between platelet count and hemoglobin level (A), as well as positive correlations between platelet count and white blood cell count (B), between platelet count and erythrocyte sedimentation rate (C), and between platelet count and admission duration (D).

Blood Research 2018; 53: 233-239https://doi.org/10.5045/br.2018.53.3.233

Fig 2.

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Figure 2.

The proportion of Kawasaki disease (navy arrow) according to the severity of reactive thrombocytosis (RT) among children who were admitted to a single Korean tertiary center. The proportion of Kawasaki disease was significantly different between the groups by reactive thrombocytosis severity, with the highest proportion in the extreme RT group (P<0.001).

Blood Research 2018; 53: 233-239https://doi.org/10.5045/br.2018.53.3.233

Fig 3.

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Figure 3.

The proportions of Kawasaki disease (navy arrow) and autoimmune inflammation (white arrow with black outline) according to patient age. The proportion of Kawasaki disease was highest in the 1–7.9-year-old group, and the proportion of inflammation was highest in the 8–18-year-old group (P<0.001). Autoimmune inflammation includes Henoch-Schönlein purpura, juvenile idiopathic arthritis, Crohn disease, and ulcerative colitis.

Blood Research 2018; 53: 233-239https://doi.org/10.5045/br.2018.53.3.233

Table 1 Baseline characteristics and underlying causes reactive thrombocytosis in 4,113 children.

^a)Autoimmune inflammation was classified separately from Kawasaki disease. ^b)Congenital malformation includes hypertrophic pyloric stenosis, Hirschsprung disease, biliary atresia, choledochal cyst, congenital hydronephrosis, imperforate anus, and tracheoesophageal fistula..

Table 2 Baseline characteristics of 87 children with extreme reactive thrombocytosis.

Table 3 Comparison of variables according to the severity of reactive thrombocytosis.

Values are presented as mean and 95% confidence intervals..

Abbreviations: ALT, alanine transaminase; AST, aspartate transaminase; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; LDH, lactate dehydrogenase..

Table 4 Comparison of the proportions of lower and upper respiratory infections, and refractory and atypical Kawasaki disease, according to the severity of reactive thrombocytosis.