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- Title
Isolated thrombocytopenia in childhood: what if it is not immune thrombocytopenia?
- Authors
Chi-wai Lee, Anselm; Lee, Anselm Chi-Wai
- Abstract
<bold>Introduction: </bold>Childhood immune thrombocytopenia (ITP) remains a diagnosis of exclusion when isolated thrombocytopenia is not part of another disease process. In practice, the diagnosis of ITP can only be confirmed when thrombocytopenia resolves or is excluded after the recognition of a primary cause.<bold>Methods: </bold>The records of 87 consecutive children with isolated thrombocytopenia seen over a nine-year period in a private paediatric haematology practice were reviewed retrospectively. Children in whom a primary cause was eventually found were the subjects of a further descriptive study.<bold>Results: </bold>9 (10%) children with isolated thrombocytopenia were not diagnosed with ITP because a primary disease was found. Of these nine cases, four had thrombocytopenia recognised during the neonatal period, consisting of perinatal cytomegalovirus infection (n = 2), meconium aspiration pneumonia (n = 1) and transient abnormal myelopoiesis associated with Down syndrome (n = 1). The remaining five children were each found to have familial thrombocytopenia, portal hypertension, cutaneous mastocytosis, May-Hegglin anomaly and systemic lupus erythematosus. Two of them had a history of failure of response to corticosteroid therapy.<bold>Conclusion: </bold>Secondary thrombocytopenia is not uncommon in a tertiary paediatric specialty practice with adequate evaluation. Thrombocytopenia occurring during the newborn period and failure of steroid therapy are predictive of secondary cases.
- Subjects
THROMBOCYTOPENIA in children; IDIOPATHIC thrombocytopenic purpura; HEMATOLOGY; CYTOMEGALOVIRUSES; MECONIUM aspiration syndrome; DOWN syndrome; MAST cell disease; CYTOMEGALOVIRUS disease diagnosis; DIAGNOSIS of Down syndrome; PNEUMONIA diagnosis; PORTAL hypertension diagnosis; SYSTEMIC lupus erythematosus diagnosis; THROMBOPENIC purpura diagnosis; DIAGNOSIS of deafness; CYTOMEGALOVIRUS diseases; DEAFNESS; DIFFERENTIAL diagnosis; LEUCOCYTE disorders; PNEUMONIA; PORTAL hypertension; SYSTEMIC lupus erythematosus; THROMBOCYTOPENIA; THROMBOPENIC purpura; RETROSPECTIVE studies; DISEASE complications; SKIN mast cell disease; DIAGNOSIS
- Publication
Singapore Medical Journal, 2018, Vol 59, Issue 7, p390
- ISSN
0037-5675
- Publication type
journal article
- DOI
10.11622/smedj.2018089