High-sensitivity C-Reactive Protein Levels at Presentation and its Association with Platelet Recovery in Newly Diagnosed Immune Thrombocytopenia in Children
Srishti Srivastava *
MCGM CTC-PHO-BMT Center, CCI Compound, Opp. Kanakia Exotica, Borivali East, Mumbai- 400066, India
Swati Kanakia
Department of Pediatrics, Lilavati Hospital & Research Center, Bandra West Mumbai, India.
Amarinder Oberoi
Department of Pediatrics, LTMMC and GH, Sion Mumbai, India.
Arpita Mishra
Department of Pediatrics, Heritage Institute of Medical Sciences, Varanasi (U.P.), India.
Amit Jain
MCGM CTC-PHO-BMT Center, Borivali, East Mumbai, India.
*Author to whom correspondence should be addressed.
Abstract
Background: Immune Thrombocytopenia (ITP) is an acquired immune mediated platelet destruction aided by the inflammatory marker high sensitivity C-Reactive Protein (hs-CRP). Higher CRP levels at presentation co-relate with retarded platelet (PLT) recovery as proposed by various studies.
Objective: To determine the quantitative level of CRP at presentation and during therapy and correlate the levels with platelet count to assess platelet recovery and be able to identify the non-responders based on the CRP level at presentation in newly diagnosed ITP.
Study Design: Prospective observational study (duration: 1year 11months).
Participants: 30 cases of newly diagnosed ITP (<18 years) after excluding secondary ITP causes.
Methods: Complete blood count, peripheral blood smear and other routine tests were done at presentation. Follow up involved platelet count and hs-CRP level estimation between Day 21-28 and Day 35-42 of diagnosis with treatment and assessing the trend of CRP with platelet count changes.
Outcomes: All patients presented with platelet count <10000/µL. On assessment of response to therapy, total 86.6% (n=26) of children showed complete response to treatment, 3 children showed partial response and 1 did not show response thereby requiring multi-drug therapy.
Results: 53.3% (n=16) cases belonged to age group 5-12 years and 53.3% (n=16) of cases were females. Mean CRP levels at presentation was 2.98 among 0-5 years old children, 2.38 (± 2.48) and 3.05 (± 2.90) in children who belonged to the age groups 5 – 12 years and 13 - 18 years respectively. CRP level among complete responders on three occasions were 2.6 (Day 1), 1.74 (Day 28) and 1.25 (Day 42) (p=0.17) and in the non-responder were 5.1 (Day 1), 5 (Day 28) against platelet count of 8000/microL and 13000/microL respectively. 92.9% cases (13/14) treated with IVIG showed complete response as compared to 80.0% (12/15) cases with oral steroid and one with Anti D.
Conclusion: Children with higher CRP at presentation and during follow up showed no/ lack of response to treatment making it a useful prognostic marker to predict the response to treatment. IVIG may lead to the faster recovery of platelet counts as compared to steroids.
Keywords: Immune Thrombocytopenia (ITP), C-reactive Protein (CRP), children, intravenous immunoglobulin (IVIG), steroid