Immune thrombocytopenic purpura in childhood: a Lebanese perspective.
Immune thrombocytopenic purpura (ITP), due to the production of antiplatelet antibodies, is the most prevalent etiology of thrombocytopenia in children and a frequent cause of consultation for the pediatrician. We review here a series of Lebanese pediatric patients presenting with ITP and we discuss the relevant characteristics of the group.


METHODS
A retrospective chart analysis was performed for 40 hospitalized or out-patient children presenting with ITP between January 1998 and December 2001. All cases except two had a diagnosis confirmed by bone marrow aspirate. Patients were equally distributed between the sexes with a mean age of 56 months. More than half of the patients had an episode of fever 2 days to 8 weeks prior to the diagnosis. For 42% of them, the disease appeared in the months between January and March. Ten percent presented with epistaxis but all of these had a platelet count less than 12,000. One-third of the patients had received immunization 2-8 weeks before the diagnosis, with one patient having a relapse 4 weeks after mumps-measles-rubella (MMR) immunization, which was 1 year after the initial cure. Initial treatment consisted of either steroids or intravenous polyvalent immunoglobulin in 58 and 36% of the cases, respectively. None of the patients had life-threatening hemorrhage. Only 10% of the patients developed chronic ITP (unremitting after 6 months).


CONCLUSIONS
ITP is generally a benign disease in infancy and childhood. Certain characteristics of ITP in this series, such as the seasonal variation and the post-vaccine ITP, will need to be better defined in larger prospective studies. Optimal treatment will eventually be targeted towards a better delineation of the disease phenotype.
Moussalem
Myrna
M
Pediatric Hematology-Oncology Division, Saint Georges Hospital affiliated with Balamand University, Beirut, Lebanon. mirnamou@inco.com.lb
Yassine
Nabil
N
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007223:Infant; D007861:Lebanon / Q000453:epidemiology; D008297:Male; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D012189:Retrospective Studies; D012621:Seasons; D013256:Steroids / Q000627:therapeutic use; D014612:Vaccines / Q000009:adverse effects
D016756:Immunoglobulins, Intravenous; D013256:Steroids; D014612:Vaccines