Introduction
Immune Thrombocytopenia (ITP) is one of the most common hematological abnormalities in children; despite the extremely low platelet count the symptoms are generally mild. Some studies have argued that a compensatory pro-coagulant plasmatic state with a protective effect exist in these patients. Our study aims to investigate this pro-coagulant state in pediatric ITP patients.
Patients and Methods
Pediatric ITP patients treated at Emek Medical Center were included. Bleeding score and laboratory parameters including platelet (Plt) count, PT- aPTT, von Willebrand factor (vWF) and Factor VIII activity at 2 different points, disease onset and during follow-up, were assessed.
Results
Thirty seven patients were included (24M/13F); median age was 3.3 (0.7-22.7) yr. Eight pts (22%) had a bleeding score of 3 (more than skin ) or more. Five patients were treated with steroids or IVIG.
Patients with an acute disease (12 mo), (p<0.025). The severity of bleeding was lower in Arab pts than in Jewish ones (p<0.02). Seventeen pts were evaluated at two time-points. The mean Plt count and vWF were 25.3 K/µl, 165.6% at point 1 and 199.1K/µl, 146.6% at point 2; respectively. Platelet count significantly increased and vWF significantly decreased between time points 1 and 2 among our patients (Z=-3.41, p<0.001; Z=2.23, p<0.03).
Discussion
A compensatory pro-coagulant state with increased vWF was found in our cohort at enrollment and declined when platelet count increased. This might explain the scarcity of severe bleeding in pediatric ITP patients.
