Immune Thrombocytopenic Purpura in Children and Adults: A Comparative Retrospective Study in IRAN


Background: Immune thrombocytopenic purpura (ITP) is an autoimmune disease that can cause bleeding disorders in patients, and presents in acute and chronic forms. The acute form is frequently seen in children, but the chronic form mainly inflicts adults. There are differences and similarities in clinical and laboratory findings of the disease between children and adults. We study these differences and similarities in these two groups of patients with ITP.
In this study, we retrospectively evaluated the clinical and laboratory data of 323 ITP cases within three years. None of our patients had a history of thrombocytopenia. Patients were classified into two groups of children (3 months to 16 years of age) and adults (≥ 16 years). Data analysis was conducted using SPSS software, and the analysis results were compared between the two age groups.
Results: Overall, the disease prevalence was higher in women than men, but the prevalence of childhood ITP was higher in males than females. The prevalence of initial symptoms including petechiae, purpura and ecchymosis was 60.5% and 61%, respectively in all patients, but severe bleeding rarely occurred in patients (28.8%). 30.5% of patients had a history of infection before developing ITP, and the children had a higher frequency of infection (80.8%). Before treatment, the mean platelet count in adults and children was 33000/μL and 35000/μL, respectively.
Comparison of data in children and adults with ITP indicated similarities and differences in clinical and laboratory findings between the two groups with differences in prevalence, bleeding symptoms, initial platelet count and infection history.

Cines DB, Blanchette VS. Immune thrombocytopenic purpura. New England Journal of Medicine. 2002;346(13):995-1008.

Provan D, Newland A. Fifty years of idiopathic thrombocytopenic purpura (ITP): management of refractory ITP in adults. British journal of haematology. 2002;118(4):933-44.

George JN, Woolf SH, Raskob GE, Wasser J, Aledort L, Ballem P, et al. Idiopathic thrombocytopenic purpura: a practice guideline developed by explicit methods for the American Society of Hematology. Blood. 1996;88(1):3-40.

Yang R, Han ZC. Pathogenesis and management of chronic idiopathic thrombocytopenic purpura: an update. International journal of hematology. 2000;71(1):18-24.

Berchtold P, McMillan R. Therapy of chronic idiopathic thrombocytopenic purpura in adults [see comments]. Blood. 1989;74(7):2309-17.

Vianelli N, Valdrè L, Fiacchini M, de Vivo A, Gugliotta L, Catani L, et al. Long-term follow-up of idiopathic thrombocytopenic purpura in 310 patients. haematologica. 2001;86(5):504-9.

Imbach P. Treatment of immune thrombocytopenia with intravenous immunoglobulin and insights for other diseases. A historical review. Swiss Med Wkly. [Historical Article Research Support, Non-U.S. Gov't Review]. 2012;142:w13593.

DeHart K, Witfill K, Miller R. IDIOPATHIC THROMBOCYTOPENIC PURPURA. Journal of the American Osteopathic College of Dermatology.22.

Kühne T, Buchanan GR, Zimmerman S, Michaels LA, Kohan R, Berchtold W, et al. A prospective comparative study of 2540 infants and children with newly diagnosed idiopathic thrombocytopenic purpura (ITP) from the Intercontinental Childhood ITP Study Group. The Journal of pediatrics. 2003;143(5):605-8.

Rodeghiero F, Stasi R, Gernsheimer T, Michel M, Provan D, Arnold DM, et al. Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood. 2009;113(11):2386-93.

Kühne T, Berchtold W, Michaels LA, Wu R, Donato H, Espina B, et al. Newly diagnosed immune thrombocytopenia in children and adults: a comparative prospective observational registry of the Intercontinental Cooperative Immune Thrombocytopenia Study Group. haematologica. 2011;96(12):1831-7.

Kühne T, Imbach P, Bolton-Maggs PH, Berchtold W, Blanchette V, Buchanan GR. Newly diagnosed idiopathic thrombocytopenic purpura in childhood: an observational study. The lancet. 2001;358(9299):2122-5.

Brighton T, Evans S, Castaldi P, Chesterman C, Chong B. Prospective evaluation of the clinical usefulness of an antigen-specific assay (MAIPA) in idiopathic thrombocytopenic purpura and other immune thrombocytopenias. Blood. 1996;88(1):194-201.

Gernsheimer T, Stratton J, Ballem PJ, Slichter SJ. Mechanisms of response to treatment in autoimmune thrombocytopenic purpura. New England Journal of Medicine. 1989;320(15):974-80.

Bussel JB, Cheng G, Saleh MN, Psaila B, Kovaleva L, Meddeb B, et al. Eltrombopag for the treatment of chronic idiopathic thrombocytopenic purpura. New England Journal of Medicine. 2007;357(22):2237-47.

Aledort LM, Hayward CP, Chen MG, Nichol JL, Bussel J. Prospective screening of 205 patients with ITP, including diagnosis, serological markers, and the relationship between platelet counts, endogenous thrombopoietin, and circulating antithrombopoietin antibodies. American journal of hematology. 2004;76(3):205-13.

Cortelazzo S, Finazzi G, Buelli M, Molteni A, Viero P, Barbui T. High risk of severe bleeding in aged patients with chronic idiopathic thrombocytopenic purpura. Blood. 1991;77(1):31-3.

Cines DB, Bussel JB. How I treat idiopathic thrombocytopenic purpura (ITP). Blood. 2005;106(7):2244-51.

Kohda K, Kuga T, Kogawa K, Kanisawa Y, Koike K, Kuroiwa G, et al. Effect of Helicobacter pylori eradication on platelet recovery in Japanese patients with chronic idiopathic thrombocytopenic purpura and secondary autoimmune thrombocytopenic purpura. British journal of haematology. 2002;118(2):584-8.

Imbach P, d'Apuzzo V, Hirt A, Rossi E, Vest M, Barandun S, et al. High-dose intravenous gammaglobulin for idiopathic thrombocytopenic purpura in childhood. The lancet. 1981;317(8232):1228-31.

Nomura S, Dan K, Hotta T, Fujimura K, Ikeda Y. Effects of pegylated recombinant human megakaryocyte growth and development factor in patients with idiopathic thrombocytopenic purpura. Blood. 2002;100(2):728-30.

Bolton-Maggs P. Idiopathic thrombocytopenic purpura. Archives of disease in childhood. 2000;83(3):220-2.

Choi CW, Kim BS, Seo JH, Shin SW, Kim YH, Kim JS, et al. Response to high‐dose intravenous immune globulin as a valuable factor predicting the effect of splenectomy in chronic idiopathic thrombocytopenic purpura patients. American journal of hematology. 2001;66(3):197-202.

Lee S, Choi E, Lee K, Ahn H. Childhood acute immune thrombocytopenic purpura: Multicenter study of Korean pediatric hematology and oncology group. Int J Hematol. 2002;76(Suppl 1):5.

Monto AS. Epidemiology of viral respiratory infections. The American journal of medicine. 2002;112(6):4-12.

Schattner E, Bussel J. Mortality in immune thrombocytopenic purpura: report of seven cases and consideration of prognostic indicators. American journal of hematology. 1994;46(2):120-6.

Buchanan GR, Adix L. Grading of hemorrhage in children with idiopathic thrombocytopenic purpura. The Journal of pediatrics. 2002;141(5):683-8.

Houwerzijl EJ, Blom NR, van der Want JJ, Esselink MT, Koornstra JJ, Smit JW, et al. Ultrastructural study shows morphologic features of apoptosis and para-apoptosis in megakaryocytes from patients with idiopathic thrombocytopenic purpura. Blood. 2004;103(2):500-6.

Kelton J. Idiopathic thrombocytopenic purpura complicating pregnancy. Blood reviews. 2002;16(1):43-6.

IssueVol 8, No 3 (2014) QRcode
Autoimmune disease Bleeding Immune thrombocytopenic purpura

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Saeidi S, Jaseb K, Asnafi AA, Rahim F, Pourmotahari F, Mardaniyan S, Yousefi H, Alghasi A, Shahjahani M, Saki N. Immune Thrombocytopenic Purpura in Children and Adults: A Comparative Retrospective Study in IRAN. Int J Hematol Oncol Stem Cell Res. 1;8(3):30-36.