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OUTCOME OF IMMUNE THROMBOCYTOPENIC PURPURA (ITP). EXPERIENCE IN A TERTIARY CARE CHILDREN HOSPITAL OF BANGLADESH
*Md. Belayet Hossain and M. Selimuzzaman
Background: The pathogenesis of Childhood ldiopathic Thrombocytopenic Purpura(ITP), a common hematological disease involves antibody-mediated platelet destruction and reduced platelet production. Though in large number of cases it resolve spontaneously but we the pediatricians very frequently use steroid or IV Immunoglobulin due to lack of experience. Object: The objective of this study was to review the presenting features, natural history and remission rate of ITP cases spontaneously or to therapy. Method: This is a retrospective study conducted in the Department of Pediatric Haematology & Oncology of Dhaka Shishu (Children) Hospital during the period January 2018 to December 2019 and there was review and analysis of natural history and treatment response in children diagnosed with ITP age ranged of 9 months to 14 years. Results: Of 64 patient with ITP with a age range of 9 months to 14 years (mean age 6.1 ± 1.6 yrs) and female predominance 36 (56 %) female and 28 (44 %) male. Male female ratio was I: 1.3. Ten (15.6%) children had major hemorhage. The platelet counts were 6,000/cmm to 1.25,000/cmm (mean 19,000/cmm). Bone marrow study was done in 14 (22%) cases with no alteration in diagnosis. Regarding outcome, 25 (39%) patients had been achieved spontaneous remission and 39 (61%) needed intervention with corticosteroid. Among the patients treated with corticosteroid 26 (67%) patients responded to corticosteroid and 13 (33%) had gone to chronic stage. Out of 13 chronic ITP patients 6 had received Anti D Ig: of these 6 patients 100% patients maintained platelet count >30,000/cmm for variable periods, and 7 patients received oral Eltrombopag-a newer drug of ITP treatment: of these 7 patients 5(71%) had responded and maintaining platelet count >50,000/cmm for longer duration than Anti D and 2(29%) did not respond. These 13 of 64 (20%) patient remained as chronic ITP. Chronic ITP developed in older children. Conclusion: The overall prognosis in childhood ITP is excellent. Spontaneous remission occurred in good number of cases (39 %) and overall about 90% cases resolved with therapy or observation. Anti-D Immunoglobulin and Eltrombopag are promising in chronic ITP though further larger study is needed.[Full Text Article]