Clinical Presentations of Idiopathic Thrombocytopenic Purpura

Abstract

Back Ground: ITP is the most common cause of thrombocytopenia in children and is a result of immunologically mediated increased platelet destruction, which is usually acute and self-limiting but may be a recurrent or chronic disorder. Aim of Study: Assessment of clinical manifestation of ITP in children. Patient and Methods: A prospective study was performed on 60 patients diagnosed as idiopathic thrombocytopenic purpura admitted to central child teaching hospital from 1st of January to 3o September 2011. Diagnosis was based on clinical and laboratory tests including bone marrow aspiration. Results: The age ranged from 6 months to 13 years and majority of cases were between 1-5 years, 68.3 % were males and 31.7 % were females, male to female ratio 2.1 : 1 . History of upper respiratory tract infection preceded the onset of illness in 71.7 % of patients. Where the Duration between Preceding URTI and ITP Up to 1 week in 30.2 % and > 1 week in 79.8 % Concerning the distribution of cases according to the season of the year: One case (1.7%) found during January, four cases (6.7%) during February, six cases (10.0%) during March, five cases (8.3%) during April, ten cases (16.7%) during May, eight cases (13.3%) during June, 14 cases (23.3%) during July , five cases (8.3%) during August, and seven cases (11. 7%) during September. This distribution was significant (P less than 0.05). The commonest presentation was cutaneous bleeding in 60 %, Mucous Membrane bleeding 1.7 %, both 38.3 % , Splenomegaly with bleeding 6.7 % , Hepatomegaly with bleeding 8.3 %, Lymphadeno-pathy with bleeding 5 % . In 69 % of cases the initial platelet count was less than 20.000 /mm³. 37.9 % had anemia. Bone marrow examination done in 56 case and all were normal. In this study, one case die due to intracranial hemo – rrhage . we didn’t include the management because the patients receive different types of treatments ( mostly by steroid , some by IVIG and anti-D ) , most of patients examined by bone marrow aspiration which was normal , and also we didn’t include the follow up because of most of the patients didn’t come for follow up. Conclusion: The disease is self-limited , most cases at age of 1-5 years , male affected more than female , most cases preceded by upper respiratory tract infections , most cases presented by skin bleeding.