Study of Immune Thrombocytopenia (ITP) in Iraqi’s children in Wasit Province

Background: Immune thrombocytopenia (ITP) is an acquired hematological autoimmune disorder characterized by accelerates destruction of platelets with premature removal from circulation and inhibition platelets production. ITP is the most common cause of thrombocytopenia in childhood age group. Typically patients are otherwise well and present with petechiae, purpura and nonpalpable ecchymoses 1-3 weeks after a viral infection. The diagnosis of ITP remains almost one of exclusion and evaluation of history and examination of the patient. The goal of therapy in ITP is to increase the platelet count enough to prevent serious hemorrhage. Aim of the study: To evaluate the possibility of diagnosis, follow up, effects of various treatment modalities on the clinical course and long term outcome in children with chronic ITP. Materials and methods: The study was involved 78 patients (40 female and 38 male) were in age range 2-10 years referred to the Hemato-Oncology unit / Al-karama teaching hospital / Wasit / Iraq. Treatment options given to children with ITP during the study period including IVIG, Prednisolon induction, PRD maintenance, DAPSONE, Anti D, Decadron high dose, N platelet and Splenectomy. Results: Male to female ratio was 1:1.05. Most of the patients (61.5%) were in age range 2-10 years, the mean of age was 72 months, range (2 months- 19 years). more than half of the patients were from center of Wasit province and seven patients were from another province. More than 80% of the patients (63) had no family history of Immune thrombocytopenia, while six patients were missed to record family history status. Fifty-five patients were sibling of consanguine father and mother. the highest number of patients was recorded in 2017 followed by 2012 and 2018. Majority of the patients presented with ecchymosis (seventy-one patients, 91%) while other types of presentation as conjunctival hemorrhage or epistaxis were recorded in less than 2.6% of the patients. Laboratory data of the patients with ITP shows that the mean Hb was 11.6 g/dl (8-15 g/dl) and mean WBC 4734 cmm (1400-25200 cmm), the platelet mean was 23000 cmm (1000-130 000 cmm). Forty-four patients did not have blood group. Bone marrow aspiration examination were done to forty five patients, the results of all them were normal. Specific investigations were done to patients with chronic ITP and according to what available in the hospital. Thirty-six patients (46.2%) were acute type and persist was reported in eight patients (10.3%) and chronic type was reported in thirty four (43.6%) patients. Most of the patients with acute ITP were with platelet count less than 20 000 cmm. While the highest percent of the patients with platelet more than 50 000 cmm were reported in chronic ITP. six patients didn't need treatment, and majority of the patients (92.3%) were treated with different types of treatment. From seventy two patients who received first line treatment, 67 patients (93.1%) were treated with prednisone induction plan. And five patients were treated with IVIG therapy when this drug was available in hospital, second line treatment was reported in 22 patients, prednisone daily low dose and dapsone was treatment plan in seven patients while five patients were received anti D as second line treatment. N plate medicine was reported in two patients and splenectomy was done for one patient. Conclusion: at this study we found female patient with ITP more than male. The consanguinity was positive and most of patients used PRD induction as first line treatment, PRD maintenance and DAPSON mostly used as second line treatment and just three patients referred to third line treatment.