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Submitted
19 November 2024
Accepted
10 December 2024
Published
11 December 2024
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Abstract

Highlights:
1. This study was the first to analyze the therapeutic response in children with ITP at Dr. Soetomo General Academic Hospital, Surabaya.
2. This study analyzed the response of platelet count and indices, including MPV, PDW, P-LCR, and PCT to therapy, which provides a more comprehensive perspective on therapy response in children with ITP.
3. This study explored the effectiveness of various therapeutic approaches based on ITP categories, offering new insights into the most effective treatment options for children with ITP.


Abstract
Immune Thrombocytopenia Purpura (ITP) is an autoimmune disorder triggered by antiplatelet autoantibodies. Clinically, ITP is classified into three phases including Newly-Diagnosed ITP, Persistent ITP, and Chronic ITP, each with distinct durations and therapy implications. Patients with ITP who do not receive appropriate or optimal treatment are at a heightened risk of morbidity and mortality related to bleeding complications, the condition could worsen, potentially resulting in fatal consequences. In ITP patients, platelet counts decrease, accompanied by abnormal shifts in platelet indices, including Mean Platelet Volume (MPV), Platelet Distribution Width (PDW), Platelet Large Cell Ratio (P-LCR), and Plateletcrit (PCT). Thus, therapeutic response in ITP patients can be evaluated through increased platelet counts and normalization of platelet indices. This study aimed to assess the therapeutic response of platelet counts and platelet indices in pediatric ITP patients by comparing pre- and post- therapy levels overall by category, across all medication types administered, and according to the specific medication used within each category. The result of this study are expected to provide an overview of the most effective treatments across all ITP categories in order to prevent severe complications and reduce the risk of mortality. This retrospective study included ITP patients under 18 years old at Dr. Soetomo General Academic Hospital, Surabaya, conducted from September 2023 to March 2024. Platelet count and platelet indices pre- and post-therapy levels were analyzed using the Paired T-test for normally distributed data and the Wilcoxon test for non-normally distributed data, with significance set at p < 0.05. In summary, there were notable changes in the pre- and post-therapy levels of platelet, MPV, PDW, P-LCR, and PCT in each ITP category and for all therapies. Platelet count and PCT increased, while MPV, PDW, and P-LCR decreased. Patients treated with prednisone exhibited the best therapeutic response. Among the categories, Newly Diagnosed ITP demonstrated the most optimal therapeutic response. Overall, ITP therapy led to significant differences between pre- and post-therapy levels, marked by an increase in platelet counts and normalization of platelet indices.

Keywords

ITP Response Therapy Platelet Platelet Indices Child Health

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How to Cite
-, R. R. C. K., Mia Ratwita Andarsini, Yetti Hernaningsih, & Pradana Zaky Romadhon. (2024). The Differences between Pre- and Post-Therapy Levels of Platelet Count and Platelet Indices in Children with Immune Thrombocytopenia Purpura. Folia Medica Indonesiana, 60(4), 298–309. https://doi.org/10.20473/fmi.v60i4.65626
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References

  1. Al-Suheel, A., Alshehri, D., Alzahrani, M., Shati, A., Almedhesh, A., Dhafer, Alshehri, B., & Alzahrani, M. (2014). Immune Thrombocytopenia among Children Living at a High-Altitude Region: A Hospital-Based Retrospective Study. Cairo Univ, 82(2). www.medicaljournalofcairouniversity.net
  2. Alwadi, K. W., Alomari, A., Alrugaib, A. K., Alrubayea, A., Alzoman, M., & Alkahtani, F. (2020). Clinical Characteristics and Outcomes of Pediatric Patients with Immune Thrombocytopenic Purpura in King Abdulaziz Medical City and King Abdullah Specialist Children’s Hospital: A 10-Year Study. Cureus, 12. https://doi.org/10.7759/cureus.11366
  3. Frelinger III, A. L., Grace, R. F., Gerrits, A. J., Berny-Lang, M. A., Brown, T., Carmichael, S. L., Neufeld, E. J., & Michelson, A. D. (2015). Platelet Function Tests, Independent of Platelet Count, are Associated with Bleeding Severity in ITP. Blood, the Journal of the American Society of Hematology, 126(7), 873–879. https://doi.org/10.1182/blood-2015-02
  4. Friedman, J. N., & Beck, C. E. (2019). Diagnosis and Management of Typical, Newly Diagnosed Primary Immune Thrombocytopenia (ITP) of Childhood. Paediatrics & Child Health, 24(1), 54–54. https://doi.org/10.1093/pch/pxy197
  5. IBM Corporation. (2023). IBM SPSS Statistics for Macintosh, Version 29.0.2.0. IBM Corporation.
  6. Kim, T. O., Despotovic, J., & Lambert, M. P. (2018). Eltrombopag for Use in Children with Immune Thrombocytopenia. Blood Advances, 2(4), 454–461. https://doi.org/10.1182/bloodadvances.2017010660
  7. Kim, T. O., & Despotovic, J. M. (2021). Pediatric Immune Thrombocytopenia (ITP) Treatment. In Annals of Blood (Vol. 6, Issue 4). AME Publishing Company. https://doi.org/10.21037/aob-20-96
  8. Kronzer, V. L., Bridges, S. L., & Davis, J. M. (2021). Why Women Have More Autoimmune Diseases than Men: An Evolutionary Perspective. Evolutionary Applications, 14(3), 629–633. https://doi.org/10.1111/eva.13167
  9. Kuter, D. J. (2021). The Treatment of Immune Thrombocytopenia (ITP)-Focus on Thrombopoietin Receptor Agonists. In Annals of Blood (Vol. 6, Issue March). AME Publishing Company. https://doi.org/10.21037/aob-21-23
  10. Lee, J. M. (2023). Advances in Management of Pediatric Chronic Immune Thrombocytopenia: A Narrative Review. In Journal of Yeungnam Medical Science (Vol. 40, Issue 3, pp. 241–246). Yeungnam University School of Medicine and College of Medicine. https://doi.org/10.12701/jyms.2022.00745
  11. Liu, X. guang, Hou, Y., & Hou, M. (2023). How We Treat Primary Immune Thrombocytopenia in Adults. In Journal of Hematology and Oncology (Vol. 16, Issue 1). BioMed Central Ltd. https://doi.org/10.1186/s13045-023-01401-z
  12. Mazzucconi, M. G., Rodeghiero, F., Avvisati, G., De Stefano, V., Gugliotta, L., Ruggeri, M., Vianelli, N., Fazi, P., Paoloni, F., Sargentini, V., Baldacci, E., Ferretti, A., Martino, B., Vincelli, I. D., Carli, G., Fortuna, S., Ianni, M. Di, Ranalli, P., Palandri, F., … Santoro, C. (2024). Prednisone vs High-Dose Dexamethasone in Newly Diagnosed Adult Primary Immune Thrombocytopenia: A Randomized Trial. Blood Advances, 8(6), 1529–1540. https://doi.org/10.1182/bloodadvances.2023010975
  13. Negash, M., Tsegaye, A., & Medhin, A. G. (2016). Diagnostic Predictive Value of Platelet Indices for Discriminating Hypo Productive versus Immune Thrombocytopenia Purpura in Patients Attending a Tertiary Care Teaching Hospital in Addis Ababa, Ethiopia. BMC Hematology, 16(1), 18. https://doi.org/10.1186/s12878-016-0057-5
  14. Neunert, C., Noroozi, N., Norman, G., Buchanan, G. R., Goy, J., Nazi, I., Kelton, J. G., & Arnold, D. M. (2015). Severe Bleeding Events in Adults and Children with Primary Immune Thrombocytopenia: A Systematic Review. Journal of Thrombosis and Haemostasis, 13(3), 457–464. https://doi.org/10.1111/jth.12813
  15. Omar, I. M., Abuelela, S., & Emam, N. (2018). Value of Pre- and Post-Treatment Platelet Indices in Patients with Immune Thrombocytopenic Purpura. Journal of Biosciences and Medicines, 06(09), 11–24. https://doi.org/10.4236/jbm.2018.69002
  16. Perera, M., & Garrido, T. (2017). Advances in the Pathophysiology of Primary Immune Thrombocytopenia. Hematology, 22(1), 41–53. https://doi.org/10.1080/10245332.2016.1219497
  17. Pietras, N. M., Gupta, N., Vaillant, A. A. J., & Pearson, A. L. (2024, May). Immune Thrombocytopenia. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK562282/
  18. Provan, D., Arnold, D. M., Bussel, J. B., Chong, B. H., Cooper, N., Gernsheimer, T., Ghanima, W., Godeau, B., González-López, T. J., Grainger, J., Hou, M., Kruse, C., McDonald, V., Michel, M., Newland, A. C., Pavord, S., Rodeghiero, F., Scully, M., Tomiyama, Y., … Kuter, D. J. (2019). Updated International Consensus Report on the Investigation and Management of Primary Immune Thrombocytopenia. In Blood Advances (Vol. 3, Issue 22, pp. 3780–3817). American Society of Hematology. https://doi.org/10.1182/bloodadvances.2019000812
  19. Saeidi, S., Jaseb, K., Asnafi, A. A., Rahim, F., Pourmotahari, F., Mardaniyan, S., Yousefi, H., Alghasi, A., Shahjahani, M., & Saki, N. (2014). Immune Thrombocytopenic Purpura in Children and Adults: A Comparative Retrospective Study in IRAN. International Journal of Hematology-Oncology and Stem Cell Research, 8(3), 30–36.
  20. Saran, K., Vidya, K., Seema, K., Prasad, A., & Prakash, J. (2022). Study of Platelet Indices and Their Role in Evaluation of Thrombocytopenia. Journal of Family Medicine and Primary Care, 11(10), 6236–6242. https://doi.org/10.4103/jfmpc.jfmpc_460_22
  21. Sari, T. T. (2018a). Immune Thrombocytopenic Purpura (Vol. 20, Issue 1).
  22. Sari, T. T. (2018b). Immune Thrombocytopenic Purpura. Sari Pediatri, 20(1), 58–64. https://doi.org/10.14238/sp20.1.2018.58-64
  23. Subramaniam, N., Mundkur, S., Kini, P., Bhaskaranand, N., & Aroor, S. (2014). Clinicohematological Study of Thrombocytosis in Children. International Scholarly Research Notices Hematology, 2014, 1–4. https://doi.org/10.1155/2014/389257
  24. Walle, M., Arkew, M., Asmerom, H., Tesfaye, A., & Getu, F. (2023). The Diagnostic Accuracy of Mean Platelet Volume in Differentiating Immune Thrombocytopenic Purpura from Hypoproductive Thrombocytopenia: A systematic Review and Meta-analysis. PLoS ONE, 18(11). https://doi.org/10.1371/journal.pone.0295011
  25. Wijaya, S. (2019). Immune Thrombocytopenia. Cermin Dunia Kedokteran, 46(11), 658–661. https://doi.org/10.55175/cdk.v46i11.402
  26. Xu, P., Han, S., Hou, M., Zhao, Y., & Xu, M. (2023). The Serum Lipid Profiles in Immune Thrombocytopenia: Mendelian Randomization Analysis and a Retrospective Study. Thrombosis Journal, 21(1). https://doi.org/10.1186/s12959-023-00551-x
  27. Yan, X., Zhang, Y., Lang, H., Huang, Z., Chen, X., He, H., Zhao, Q., & Wang, J. (2023). Research on the Mechanism of Prednisone in the Treatment of ITP via VIP/PACAP-Mediated Intestinal Immune Dysfunction. European Journal of Medical Research, 28(1). https://doi.org/10.1186/s40001-023-00987-x
  28. Yao, X., Li, C., Yang, J., Li, C., & Xia, Y. (2016). Differences in Frequency and Regulation of T Follicular Helper Cells between Newly Diagnosed and Chronic Pediatric Immune Thrombocytopenia. Blood Cells, Molecules, and Diseases, 61, 26–36. https://doi.org/10.1016/j.bcmd.2016.06.006