Predictors of Remission following IVIG in Newly Diagnosed Childhood Immune Thrombocytopenia

Abstract

Immune Thrombocytopenia (ITP) is the most common acquired autoimmune bleeding disorder in children, and only 20-25 % progress to chronic ITP. Intravenous immunoglobulin (IVIG) is recommended as one of the first-line therapeutic options for those with significant mucosal or life-threatening bleeding in ITP. Predictors of remission following IVIG therapy have not been fully explored yet. Now trying to individualize IVIG therapy for ITP children who have special demographic, clinical, and therapeutic predictors of remission following IVIG therapy. Aim: To evaluate the demographic, clinical, and laboratory predictors of remission following IVIG therapy in newly diagnosed ITP children. This retrospective observational study included 142 children with newly diagnosed ITP aged 1-9 years who were treated with IVIG as initial therapy and admitted to Benghazi University Children's Hospital from January 2019 to April 2024. We revised their medical records to demographic, clinical, and laboratory characteristics at diagnosis and during follow-up to 1 year post-IVIG therapy. Results: ¾ (75.4%) of our study ITP children were ≤ 5 years old, with male predominance 91 (64.1%). Only 12.7% (n=18) of our study group developed chronic ITP, while the majority, 87.3% (n=124), were complete responders and achieved disease remission. Our study confirmed that children ≤ 5 years (p = 0.037) and an abrupt onset of the disease (p = 0.028), in addition to platelet counts >100 × 10⁹/L at one month (p = 0.036) and at three months (p = 0.000) after IVIG therapy, are good predictors of remission following IVIG therapy in newly diagnosed ITP children. Our study concluded a higher remission rate (87.3%) following an initial course of IVIG therapy for ITP. In addition, children ≤ 5 years, an abrupt onset of the disease, platelet count ≥100×10⁹/L at 1 and 3 months, are good predictors of remission following IVIG therapy in newly diagnosed ITP.