| Abstract [eng] |
Introduction. Immune thrombocytopenia is the most common acquired thrombocytopenia and bleeding disorder in children, characterized by a variety of clinical manifestations and an unpredictable course. To date, there has been a lack of data on the clinical presentation and treatment patterns of children with immune thrombocytopenia in Lithuania. The aim of the study. To assess the severity of bleeding, treatment approaches, and disease course in children with immune thrombocytopenia. Methods. A retrospective analysis of children with immune thrombocytopenia treated in the Children's Oncohematology Unit of Vilnius University Hospital Santaros Clinics from January 1, 2018, to December 31, 2023, was conducted. The study included patients who met the inclusion and exclusion criteria. Demographic, clinical, and treatment data of the patients were assessed. The severity of bleeding was determined using the Buchanan and Adix bleeding score. The response to treatment was evaluated using the criteria recommended by the International Working Group. Statistical data analysis was performed using IBM SPSS software. Results. A total of 68 patients with newly diagnosed immune thrombocytopenia were included in the analysis. The median age (IQR) of the patients was 4 (1–7.75) years; the majority were in the 1–5-year age group (38.2%) and were male (51.5%). Most cases occurred during winter (32.4%). Approximately 72.1% of patients had a history of infection prior to diagnosis, most commonly an acute upper respiratory tract infection (57.1%). Bleeding symptoms were observed in 97.1% of the patients, most frequently petechiae (82.4%) and ecchymosis (76.5%) on the skin. The median (IQR) initial platelet count was 5.5 (3–10) × 10⁹/L. Moderate bleeding severity was observed in 54.4% of the patients. The median bleeding severity score was statistically significantly higher in boys than in girls (p = 0.03). Active treatment was provided to 77.9% of the patients. The median initial platelet count in patients managed with a watch-and-wait strategy was higher than in those who received active treatment (p < 0.001). Intravenous immunoglobulin was used in 75% of the cases. A response or complete response to treatment was observed in 86.5% of cases. Adverse reactions were noted in 15.1% of patients who received active treatment. The chronic phase of the disease was observed in 1.5% of patients. Conclusions. Immune thrombocytopenia was most commonly diagnosed in boys aged 1–5 years who had recently suffered from an acute upper respiratory tract infection during the winter season. The most frequent bleeding symptoms were petechiae and ecchymoses on the skin. Most patients had moderate bleeding, with boys experiencing a statistically significantly higher bleeding severity. The majority of children were treated actively, most often with intravenous immunoglobulin monotherapy, which proved to be both effective and safe. The disease course was mostly benign. |
