Abstract Ref Number = APCP894
CLINICAL CHARACTERISTICS OF IMMUNE THROMBOCYTOPENIA IN CHILDREN – A SINGLE CENTRE STUDY OVER 11 YEARS IN SINGAPORE
Carin Loh,Rajat Bhattacharyya,Joyce Lam,Judith Wong
Yong Loo Lin School of Medicine National University of Singapore Department of Paediatric Haematology Oncology and Stem Cell Transplant, KK Womens and Childrens Hospital, Singapore Department of Childrens Intensive Care Unit, KK Womens and Childrens Hospital, Singapore
Background : Management of childhood Immune Thrombocytopenia (ITP) has seen a shift towards non-intervention in western countries whereas there is paucity of data in South East Asia. This study aims to understand the characteristics and outcomes of local paediatric ITP.
Material : This is a retrospective review of children aged 0-16 years diagnosed with ITP from 2003-2013 identified from the hospital electronic database. Bleeding severity, investigations, treatment and outcomes were noted. Categorical and continuous variables are respectively (i) presented as counts (percentages) and median (interquartile ranges); and (ii) analysed with Chi-square or Mann-Whitney U tests.
Results : A total of 232 patients were included in the analysis. Median age at diagnosis was 3.4 (1.5, 6.0) years, with 123 (53.0%) males and 109 (47.0%) females. Bleeding severity (WHO grading) of mild, moderate and severe were identified in 181 (78.0%), 44 (19.0%) and 7 (3.0%) children respectively. Bleeding severity in children with lowest platelet count of <10 x 109/L was mild in 97 (74.0%), moderate in 28 (21.4%) and severe in 6 (4.6%) which was not statistically different to children with lowest platelet count >10 x 109/L; 84 (83.2%) mild, 16 (15.8%) moderate and 1 (1.0%) severe (p=0.138). Observation alone and platelet raising therapy were used in 166 (71.6%) and 66 (28.4%) children respectively. Development of chronic ITP occurred in 39 (23.5%) patients who were observed and 19 (28.8%) who received treatment (p=0.395). All 7 (100.0%) patients with severe bleeding were treated, 25 (56.8%) with moderate bleeding were observed and 40 (22.1%) with mild bleeding were treated (p=<0.001).
Conclusions : Clinical characteristics and outcomes of the local paediatric ITP population are comparable with western literature, with poor correlation of platelet count with bleeding and development of chronicity and outcomes in observed vis-a-vis treated groups. Future studies with more recent patient cohorts will be helpful in identifying the trend toward non-intervention
Keywords: Immune Thrombocytopenia Clinical Characteristics Singapore