Immune Thrombocytopenia in Children in a Second-level Hospital

Background: Immune thrombocytopenia is one of the most common causes of symptomatic thrombocytopenia in children. It’s an immune-mediated acquired disease, characterized by transient or persistent decrease of platelet count, and is usually benign.

Objective: The aim of our study is to describe clinical characteristics of the disease in children observed in a second-level hospital in Portugal.

Methods: The authors present a 10-year retrospective review of 21 patients attended at the Pediatric Department in our hospital, between 2009 and 2019. We included all children under the age of 18 years with isolated thrombocytopenia (platelet count < 100x10^3 /uL) not triggered by an apparent associated condition.

Results: The group included 22 children with a greater incidence in the age 1-5 years (62%) and a total of 68% females. All the children older than 5 years were girls.

All patients presented with cutaneous haemorrhage and 32% had additional mucosal involvement. No central nervous system, gastrointestinal or severe mucosal bleeding requiring hospitalization was found. Approximately half of cases were preceded by an infection (45%).

Ninety one percent of the children present with a platelet count equal or below 20x10^9/L. Intravenous immunoglobulin (IVIg) was administered to nearly all (95%) patients.

Children who relapse after two or more courses of IVIg (23%) were referred to a Pediatric haematology unit at a tertiary care hospital, and were treated with corticosteroids. All of them developed chronic disease, except one. Two patients underwent complete remission, by 23 to 40 months from diagnosis.

In the group of children older than 5 years 63% needed to be treated with corticosteroids after IVIg, in comparison with none in the group of 5 years or less.

Conclusion: The descriptive analysis of our sample reveals that our findings are in line with other international reports.