Clinical and Laboratory Characteristics of Newly diagnosed versus Chronic Primary ITP Children in a Tertiary Center

Abstract

Background: Immune thrombocytopenia is the most common acquired bleeding disorder in children, characterized by isolated thrombocytopenia with otherwise normal hematologic parameters. The clinical course varies from transient, self-limiting thrombocytopenia to chronic, treatment refractory disease. Comparative characterization of newly diagnosed and chronic pediatric ITP may provide insights into disease behavior and management trends.

Aim: To compare the clinical presentation, laboratory parameters and treatment strategies between newly diagnosed and chronic pediatric primary immune thrombocytopenic patients in order to identify potential differences that may influence disease understanding and management.

Patients and methods:  This comparative cross sectional study included 25 newly diagnosed ITP children (Group A) and 25 children with chronic ITP (Group B). Our patients were selected  from Pediatric Hematology and Oncology Unit, Minia University Children Hospital. Participants underwent medical history, clinical examination  and complete blood count. Demographic data, clinical parameters, treatment modalities and laboratory findings were analyzed.

Results: The mean of age among the studied groups showed a statistically significant difference with chronic ITP patients being notably older (10.3 ± 2.44 years) than those of newly diagnosis (7.64 ± 1.97 years),p<0.001. Chronic ITP patients demonstrated significantly higher use of thrombopoietin receptor agonists (44% vs. 16%, p = 0.006). Patients of chronic group exhibited lower hemoglobin levels compared to newly diagnosed group (10.5 ± 0.87 vs. 11.0 ± 0.80 g/dl, p = 0.043) and higher platelet counts (28.1 ± 7.67 vs. 12.3 ± 5.72 × 10³/ml, p < 0.001). Both groups exhibited similar bleeding patterns, with purpura and ecchymosis as the predominant manifestations, and no significant difference in bleeding severity (p = 0.571). Total leukocyte counts showed no significant differences among studied groups. Sex distribution in both groups did not differ significantly (60% males in Group A vs. 44% in Group B, p = 0.258). Similarly, positive consanguinity showed no significant difference (44% vs. 40%, p = 0.774)

Conclusion: Our study concluded that the mean age of children with chronic ITP was significantly higher than that of those with newly diagnosed ITP. Therapeutic patterns differed significantly, with corticosteroids and IVIG being the mainstay in newly diagnosed cases, while thrombopoietin receptor agonists were predominantly used in chronic disease. Chronic ITP patients had significantly lower hemoglobin levels, while platelet counts were higher. Study groups presented mainly with cutaneous bleeding but severe hemorrhagic events were absent.