title: Platelet count, previous infection and FCGR2B genotype predict development of chronic disease in newly diagnosed idiopathic thrombocytopenia in childhood: results of a prospective study.
abstract: About 25-30% of children with acute idiopathic thrombocytopenia (ITP) develop chronic disease. It is not well known which patient characteristics influence the course of the ITP. A prospective study in 60 children with newly diagnosed ITP was performed. The aim of the study was to identify patient characteristics at the onset of thrombocytopenia that predicts the progression to chronic ITP. Clinical data and blood samples were collected at several time points during the first 6 months of the disease. Variables predicting chronic disease, as calculated in a multivariate logistic regression analysis, were a platelet count >10 x 10(9)/l at the onset [odds ratio (OR) 1.1, 95% confidence interval (CI) 1.01-1.14], the absence of infection shortly before the onset of the disease (OR 4.8, CI 1.16-19.57) and FGR2B-232I/T genotype (OR 7.9, CI 0.96-65.27). The latter may point at an immune-modulating role of Fc gamma RIIb in ITP. Although only three patients had serious bleeds, 35 patients received immune-modulating treatment for low platelet counts only. Seventeen patients were treated with intravenous immunoglobulin (IVIG) and 18 patients received corticosteroids. Patient variables did not differ between these treatment groups. However, patients receiving IVIG had significantly lower risk for chronic disease.
authors.affiliation: University Children's Hospital The Wilhelmina Children's Hospital, University Medical Centre, Utrecht, The Netherlands.
authors.forename: Marrie
authors.initials: M
authors.lastname: Bruin
authors.forename: Marc
authors.initials: M
authors.lastname: Bierings
authors.forename: Cuno
authors.initials: C
authors.lastname: Uiterwaal
authors.forename: Tom
authors.initials: T
authors.lastname: Révész
authors.forename: Lonneke
authors.initials: L
authors.lastname: Bode
authors.forename: Marie-Elize
authors.initials: ME
authors.lastname: Wiesman
authors.forename: Taco
authors.initials: T
authors.lastname: Kuijpers
authors.forename: Rienk
authors.initials: R
authors.lastname: Tamminga
authors.forename: Masja
authors.initials: M
authors.lastname: de Haas
mesh_terms: D000293:Adolescent; D001323:Autoantibodies / Q000097:blood; D001792:Blood Platelets / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D005838:Genotype; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D016756:Immunoglobulins, Intravenous; D007167:Immunotherapy; D007223:Infant; D016015:Logistic Models; D008297:Male; D010976:Platelet Count; D019038:Platelet Glycoprotein GPIb-IX Complex / Q000032:analysis; D011110:Polymorphism, Genetic; D011446:Prospective Studies; D017452:Receptors, IgG / Q000235:genetics*; D012008:Recurrence; D013921:Thrombocytopenia / Q000097:blood* / Q000235:genetics* / Q000628:therapy; D013926:Thrombopoietin / Q000032:analysis
chemical_list: D001323:Autoantibodies; C499173:FCGR2B protein, human; D005938:Glucocorticoids; D016756:Immunoglobulins, Intravenous; D019038:Platelet Glycoprotein GPIb-IX Complex; D017452:Receptors, IgG; C023592:glycocalicin; D013926:Thrombopoietin