Childhood idiopathic thrombocytopenic purpura in the Nordic countries: Epidemiology and predictors of chronic disease

Paediatric Department of National Hospital of Norway, Oslo, Norway.
Acta Paediatrica (Impact Factor: 1.67). 02/2005; 94(2):178-84. DOI: 10.1111/j.1651-2227.2005.tb01887.x
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To describe the epidemiology of idiopathic thrombocytopenic purpura (ITP) in the Nordic countries, to define clinical subgroups and to investigate factors predicting chronic disease.
A prospective registration was done from 1998 to 2000, including all children with newly diagnosed ITP aged 0-14 y and at least one platelet count <30 x 10(9)/l.
506 children were registered and 423 followed for 6 mo. The incidence was 4.8/10(5) per year. Most children were aged 0-7 y (78%), with a predominance of boys, while patients aged 8-14 y had equal representation of the two sexes. There were seasonal variations determined by variations in postinfectious cases with sudden onset. The platelet count was <10 x 10(9)/l in 58%, but bleeding manifestations were mild or moderate in 97%. The insidious form (symptoms for more than 2 wk) was more frequent in older children and girls, showed little seasonal variation, had milder manifestations and ran a chronic course in more than half the cases. Intracranial haemorrhages did not occur in the first 6 mo after diagnosis. Chronic ITP developed in 25%. The strongest predictor of chronic disease was insidious onset of symptoms (OR 5.97).
In the Nordic countries, ITP mainly affects children aged 0-7 y, with a winter bulk of postinfectious cases superimposed on a steady occurrence of non-infectious cases. Clinically, it may be useful to distinguish between children with sudden versus insidious onset of symptoms rather than between different age groups.

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    • "Because immunization may be a surrogate for age , it is possible that an observed correlation between risk of ITP and immunization is an artefact . However , previous studies examining this association ( Farrington et al , 1995 ; Black et al , 2003 ; Zeller et al , 2005 ) have tightly controlled for age , thus minimizing the confounding effect of age and further supporting immunizations , particularly the MMR vaccine , as a probable casual factor in pediatric ITP . There were several other differences in the GPRD records of adult ( Schoonen et al , 2009 ) and paediatric cases of ITP that may suggest different disease characteristics , differential data collection , or variation in practice patterns by age . "
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    ABSTRACT: This study assessed the incidence of immune thrombocytopenia (ITP) and characteristics associated with ITP in the paediatric population using the General Practice Research Database (GPRD). Two hundred and fifty-seven paediatric ITP patients were identified out of 1145 incident patients with ITP recorded between 1990 and 2005. The age-specific incidence for ITP in paediatric patients was 4.2 per 100,000 person-years (PY) [95% confidence interval (CI): 3.7-4.8 per 100,000 PY], with a statistically significantly higher incidence in boys compared to girls aged 2-5 years [9.7 (95% CI: 7.5-12.2) per 100,000 PY vs. 4.7 (95% CI: 3.2-6.6) per 100,000 PY, respectively]. By contrast, among teenagers aged 13-17 years, the overall incidence was lower [2.4 (95% CI: 1.7-3.3) per 100,000 PY] with a similar incidence in girls and boys. There was a relationship between age and sex with ITP incidence, suggesting that patterns of disease burden differ among children and teenagers. Evidence of an infection or immunization shortly before ITP diagnosis was apparent in 52 (20.2%) and 22 (8.6%) of the 257 paediatric ITP patients, respectively. Two deaths were observed during the study period. ITP is an important although rarely fatal disease in paediatric patients and its aetiology remains unexplained in the majority of cases.
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    ABSTRACT: Childhood immune thrombocytopenic purpura (ITP) is an uncommon, generally self-limiting, heterogeneous condition usually with a good outlook. Most children recover quickly without serious bleeding complications irrespective of specific treatment to raise the platelet count. The low platelet count was thought to equate to a risk of serious bleeding, but several population studies have confirmed that this risk is low, around 3–4%, and intracranial haemorrhage is rare. Most children do not require active treatment. Assessment of bleeding by a clinical score is required together with assessment of quality of life issues that help to determine whether invasive investigations and treatment are worse for the child than the illness itself. Advances have been made in understanding the pathogenesis, and new treatments have been developed, some of which have been tried with success in children.
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