IDIOPATHIC THROMBOCYTOPENIC PURPURA (ITP);

Frequency of clinical features in children

Abstract

Objective: To find the frequency of common clinical features of Idiopathic Thrombocytopenic Purpura (ITP) in children
and to see whether bone marrow aspiration needed in every child with typical presentation of ITP. Design: Cross-sectional study. Setting:
Hematology/Oncology Department, the Children Hospital & the Institute of Child Health Lahore Pakistan. Duration: April 2008 to March
2009 (One year). Material and Methods: A total of 30 children presenting with bleeding through any orifice with diagnostic evidence of
ITP were evaluated by a cross sectional study. Common clinical features were recorded along with the related hematological parameters.
After taking detailed history and thorough examination, relevant investigations like peripheral smear, bleeding time and coagulation screen
were carried out in all cases. Bone marrow examination was done only in selected cases. The cases were then managed according to
standardized management criteria. Results: Male: Female ratio was 3:2, age ranging from 18 months to 14 years (mean±SD of 5.2±
years) with median age of 5.2 years. 26.6% (n=08) patients were having preceded history of upper respiratory tract infection. The
positive clinical findings were bruises in 30% (n=09) cases; petechiae in 23.3% (n=07) cases; epistaxis in 23.3% (n=07) cases; gum
bleeding in 13.3%(n=04) cases and hematuria only in 10% (n=03) cases. Anemia (<9gm%) was noted in 40% (n=12) patients. On
peripheral smear examination this was microctic hypochromic in nature. Bleeding time was prolonged in all patients in line with
documented thrombocytopenia i.e platelet count < 150,000. PT/APTT was normal in all 30 patients. Conclusions: Bruises, Petechiae
and epistaxis are the commonest clinical findings of ITP. Bone marrow aspiration revealed inconclusive results in such cases.