ABSTRACT
Objective To analyze the changes of PAIgG, CD62P, CD4+CD25+ Foxp3+Tr,and IL-18 before and after treatment in peripheral blood of children with acute idiopathic thrombocytopenic purpura(ITP) and investigate the function of these factors in the pathogenesis of ITP.Methods Forty-one cases of acute ITP children were divided into the effective group(35cases) and the ineffective group (6cases) according to the clinical treatment. To detect PAIgG,CD62P,and the number of Tr cells by using flow cytometry ,IL-18 plasma levels by ELISA assay,and analyze the variations of these indicators before and after treatment in children with acute ITP. Results In the effective treatment group, PAIgG, CD62P before treatment were 53.05%,(14.18±5.04 )%, which were significantly higher than that after treatment [18.62%, ( 8.36±1.95 )%] and control group[5.26%,(2.65±0.59) %,all P<0.01],and PAIgG,CD62P after treatment were also higher than that in control group [all P<0.05].IL-18,CD4 + T lymphocytes, Tr/CD4+T-lymphocyte ratios before treatment [415.47 ±38.92 ) ng/L,( 25.64 ± 5.81 )%,( 2.67 ± 0.14 )%]were significantly lower than that after treatment [(512.85±42. 17)ng/L,(35.08±6.07)% ,(4.76±0.58)%] and control group[(506. 39±32.28) ng/L,(35.32±2.27)% ,(5.37 ±0.69)% ,all P<0.01]. IL-18, CD4 +T lymphocytes, Tr/CD4 +T-lymphocyte ratios after treatmenthad no statistically significant difference compared with control group( all P<0.05 ). In ineffective group, the test results of PAIgG, CD62P, IL-18, CD4 +T lymphocytes, Tr/CD4+ T-lymphocyte ratios showed no significant change before and after treatment( all P<0.05 ).IL-18 had negative correlations with PAIgG,CD62P respectively before and after treatment(all P<0.05 ). Tr cells / CD4 + T had negative correlations with PAIgG,CD62P respectively (all P<0.05). Conclusions The amount of Tr, IL-18 were reduced, while CD62P and PAIgG increased in peripheral blood of children with acute ITP. IL-18, Tr , CD62P and PAIgG play important roles in the pathogenesis of acute ITP.
ABSTRACT
PURPOSE: The age-related clinical expression of acute idiopathic thrombocytopenic purpura (acute ITP) in children is unclear. In particular, information about acute ITP during the first year of life is limited. To find several features distinguishing infants from older children with acute ITP. We evaluated the clinical features, laboratory data, treatment outcomes of childhood acute ITP. METHODS: We retrospectively analysed the data of newly diagnosed 61 children with acute ITP at Pusan National University Hospital between January 1999 and December 2003. RESULTS: The mean age at the diagnosis of childhood acute ITP in our study was 4.7+/-3.9 years of age. In the age groups less than 1, 1~10 and older 10 years there were 14 (23.0%), 37 (60.6%), 10 (16.4%) cases, respectively. Male to female ratio was 1.6 : 1. The mean platelet count at the diagnosis of acute ITP in infants was significantly lower compared to the older age groups (P=0.001). Infants responded favorably to initial intravenous immunoglobulin treatment compared to the older age groups (P < 0.05). In infants, platelet count began to rise rapidly after initial intravenous immunoglobulin treatment. Among the 61 cases who were followed up over 6 months, 14 cases (23.0%) progressed to chronic ITP. Chronic ITP was seen significantly less frequently in infants (7.4%) than other age groups (P < 0.05). CONCLUSION: Infants with acute ITP tend to respond favorably to initial intravenous immunoglobulin treatment. Also, they are less likely to develop chronic ITP compared to the older children.
Subject(s)
Child , Female , Humans , Infant , Male , Diagnosis , Immunoglobulins , Platelet Count , Purpura, Thrombocytopenic, Idiopathic , Retrospective StudiesABSTRACT
BACKGROUND: Acute idiopathic thrombocytopenic purpura(ITP) is one of the common hematologic disorders in children. Bone marrow aspiration(BMA) is often performed in children with acute ITP to rule out leukemia, aplastic anemia or other hematologic diseases. However, whether BMA is needed in children with typical clinical and hematological features of acute ITP have been questioned. This study was performed to examine the proper indication of BMA in acute childhood ITP. MATERIALS AND METHODS: The medical records and BMA reports of children with the provisional diagnosis of acute ITP were reviewed from January 1984 to December 2000. Patients were divided into two groups, one with typical and another with atypical clinical and hematological features of acute ITP. Typical acute ITP group was characterized by the history of previous viral infection, well being appearance, no hepatosplenomegaly, no lymphadenopathy, normal Hb, WBC, neutrophil count and peripheral blood smear except thrombocytopenia. A platelet count of 50x109/L or lower was the cutoff level. RESULTS: Total 120 children with the provisional diagnosis of acute ITP were included. One hundred eighteen of them were confirmed to have acute ITP by BMAs. Of these, 66 had typical and 54 had atypical features. All of typical features and 52 of 54 with atypical features of acute ITP were confirmed to have acute ITP by BMAs. Two patients with atypical features of acute ITP were diagnosed as aplastic anemia and myelodyspalstic syndrome, respectively, by BMAs. CONCLUSION: This study concludes that BMA is not needed for the children with typical features of acute ITP but it is needed for the children with atypical features of acute ITP to rule out other hematologic disorders.