Clinical and laboratory predictors of chronic immune thrombocytopenia in children: a systematic review and meta-analysis

Department of Pediatric Hematology and Oncology, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht, The Netherlands;, Department of Pediatric Hematology and Oncology, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht, The Netherlands;, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands;, Department of Immunohematology, Sanquin Research, Amsterdam, The Netherlands; and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands., Department of Pediatric Hematology and Oncology, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht, The Netherlands;

Blood. 2014;124((22):):3295-3307.
Abstract
Childhood immune thrombocytopenia (ITP) is a rare autoimmune bleeding disorder. Most children recover within 6 to 12 months, but individual course is difficult to predict. We performed a systematic review and meta-analysis to identify predictors of chronic ITP. We found 1399 articles; after critical appraisal, 54 studies were included. The following predictors of chronic ITP in children, assessed in at least 3 studies, have been identified: female gender (odds ratio [OR] 1.17, 95% confidence interval [CI] 1.04-1.31), older age at presentation (age >11 years; OR 2.47, 95% CI 1.94-3.15), no preceding infection or vaccination (OR 3.08, 95 CI 2.19-4.32), insidious onset (OR 11.27, 95% CI 6.27-20.27), higher platelet counts at presentation (>20 x 10(9)/L: OR 2.15, 95% CI 1.63-2.83), presence of antinuclear antibodies (OR 2.87, 95% 1.57-5.24), and treatment with a combination of methylprednisolone and intravenous immunoglobulin (OR 2.67, 95% CI 1.44-4.96). Children with mucosal bleeding at diagnosis or treatment with intravenous immunoglobulin alone developed chronic ITP less often (OR 0.39, 95% CI 0.28-0.54 and OR 0.71, 95% CI 0.52-0.97, respectively). The protective effect of intravenous immunoglobulin is remarkable and needs confirmation in prospective randomized trials as well as future laboratory studies to elucidate the mechanism of this effect. 2014 by The American Society of Hematology.
Study details
Study Design : Systematic Review
Language : English
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine