Immune Thrombocytopenia among Children Living at a High Altitude Region: A Hospital-Based Retrospective Study
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- Category: Vol. 82, December 2014
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Immune Thrombocytopenia among Children Living at a High Altitude Region: A Hospital-Based Retrospective Study, ALI AL-SUHEEL, AYED SHATI, SULTAN A. ALMEDHESH, DHAFER B. ALSHEHRI and MOHAMED ALZAHRANI
Abstract
Objective: To identity the pattern of immune thrombocy-topenia (ITP) and to describe presenting features, laboratory characteristics and outcome of the ITP among Saudi children living at a high altitude area.
Methodology: A retrospective descriptive study design was followed at the Pediatric Medical Department of Aseer Central Hospital, during the period from January 2011 till December 2013. All data of children aged 6 months till 12 years with the diagnosis of ITP during the study period (n=46) were included into this study.
Results: More than half of patients were females (58.7%). Most of them were diagnosed before the age of 6 years (86.9%). More than half of patients had their ITP attack after infection (58.7%). Only one patient had positive family history (2.2%). The most common symptoms were skin rash (93.5%) and epistaxis (41.3%), which was significantly more among male children. The most common signs were ecchymosis (87%), purpura (76.1%), petechial rash (60.9%), bleeding in mucous membranes (58.7%) and pallor (32.6%). Splenomegaly was present in 6.5% of patients. Platelet count of most children (80.4%) was less than 20x103/ml, 37% had low hemoglobin level (5-12gm/dL). ESR was >30mm/hour in almost one fourth of patients. Peripheral blood smears showed isolated thromb-ocytopenia in 82.6% of patients, megakaryocytes in 15.2% and pancytopenia in 2.2% of patients. Bone marrow aspiration was performed for 28 cases (60.9%) to confirm diagnosis (50%), to start steroids treatment (4.3%), for pancytopenia (4.3%) or splenomegaly (2.2%). On discharge, the condition of 63% of children with ITP was completely resolved, with a higher cure rate among boys than girls (84.1% and 48.1%, respectively), 34.8% had chronic ITP, with a lower proportion among boys than girls (15.8% and 48.1%, respectively). One child died (2.2%), who was a girl. Differences between male and female children with ITP regarding their outcome at discharge were statistically significant (p=0.042).
Conclusions: There are higher predilection of ITP and significantly lower cure rates among girls than boys. These findings need further epidemiological, biochemical and he-matological studies to be explained.