Managing Childhood Immune Thrombocytopenia in a Government Facility in India; Perspective from an LMIC

Background and Aims: The pathophysiology and treatment of immune cytopenia, especially Immune thrombocytopenia (ITP) has evolved in recent times. Childhood ITP is mostly self-limiting, where spontaneous recovery is the norm. In this study, we evaluated the treatment and follow up data of children with ITP treated at our centre Methods: Clinical, haematological and outcome data of patients aged 0-18 years with ITP between April 2017- March 2022 (60 months) were analysed. Results: 144 patients were registered. The median age was 7 years (0.3-18 years). M:F was 1.52:1. Initial platelet count ranged from <1000 to 62,000/mL. Bone marrow evaluation was done in 92 patients. 2 were excluded for an alternative diagnosis (TTP, CAMT). 1 patient's data was not available. Treatment was given to those with platelet count <20,000/mL or mucosal bleeding. Standard definitions were followed. Out of 142 patients with ITP, 82 (57%) were acute/newly diagnosed, 14 had persistent, 37 (26%) had chronic disease and 9 had recurrent presentations with intermittent remissions. All patients received Prednisolone as first agent. 51 patients (from persistent and chronic) received Dapsone. 3^rd line included other immunosuppressives, rituximab and TPO agonists. The median follow-up was for 40 months (3-54 months). 67% are in remission and 3 were lost to follow-up after remission. 20 attained partial response (platelet count >10,000/mL) and are either on no treatment or continued on dapsone. 6 patients were LTFU before remission was achieved. 7 patients have no response, continue to have platelet count <10,000/mL. 3 children have WAS, 1 XLT, 1 Biotinidase deficiency and 1 combined immunodeficiency. 1 child each has psoriasis, leukoderma, HIV and 2 have lupus. Conclusions: The natural history of the disease still remains to be one of spontaneous remissions. Among chronic and persistent ITP, alternative diagnoses emerged. Dapsone response in >60% chronic cases.

No relevant conflicts of interest to declare.