Original Article

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Blood Res 2016; 51(2):

Published online June 23, 2016

https://doi.org/10.5045/br.2016.51.2.95

© The Korean Society of Hematology

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

Hyoung Soo Choi*, Mi Hong Ji, Sung Jin Kim, and Hyo Seop Ahn

Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea.

Correspondence to : Correspondence to Hyoung Soo Choi, M.D., Ph.D. Department of Pediatrics, Seoul National University Bundang Hospital, 82 Gumi-ro, 173-beon-gil, Bundang-gu, Seongnam 13620, Korea. choihs1786@snubh.org

Received: February 20, 2016; Revised: March 20, 2016; Accepted: April 27, 2016

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

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 ≥100×103/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.

Keywords Childhood, Immune thrombocytopenia, Intravenous immunoglobulin, Prognostic factor

Article

Original Article

Blood Res 2016; 51(2): 95-101

Published online June 23, 2016 https://doi.org/10.5045/br.2016.51.2.95

Copyright © The Korean Society of Hematology.

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

Hyoung Soo Choi*, Mi Hong Ji, Sung Jin Kim, and Hyo Seop Ahn

Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea.

Correspondence to: Correspondence to Hyoung Soo Choi, M.D., Ph.D. Department of Pediatrics, Seoul National University Bundang Hospital, 82 Gumi-ro, 173-beon-gil, Bundang-gu, Seongnam 13620, Korea. choihs1786@snubh.org

Received: February 20, 2016; Revised: March 20, 2016; Accepted: April 27, 2016

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

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 ≥100×103/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.

Keywords: Childhood, Immune thrombocytopenia, Intravenous immunoglobulin, Prognostic factor

Fig 1.

Figure 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).

Blood Research 2016; 51: 95-101https://doi.org/10.5045/br.2016.51.2.95
Patient characteristics.

Abbreviations: IVIG, intravenous immunoglobulin; WBC, white blood cell..


Comparison between the complete response group and the persistent ITP group at 6 months of IVIG treatment.

Abbreviations: ITP, immune thrombocytopenic purpura; IVIG, intravenous immunoglobulin; ND, not done; WBC, white blood cell..


Comparison between the complete response group and the chronic ITP group at 12 months after IVIG treatment.

Abbreviations: ITP, immune thrombocytopenic purpura; IVIG, intravenous immunoglobulin; ND, not done; WBC, white blood cell..


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