Idiopathic thrombocytopenia and neutropenia in childhood.

S Calderwood, V Blanchette, J Doyle, J Freedman, D Stroncek, A Zipursky
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Abstract

Purpose: Between 1975 and 1990, 13 patients seen at The Hospital for Sick Children, Toronto, Ontario, were noted to have concurrent idiopathic thrombocytopenia and neutropenia (ITN; platelet count < 150 x 10(9)/L; absolute neutrophil count < 1.5 x 10(9)/L). These patients all had normal marrow function and no evidence of systemic disease.

Patients and methods: A detailed chart review was performed to define the clinical and laboratory features of these patients.

Results: Although this was a heterogeneous group of patients, they shared several common characteristics. The disease followed a chronic course with thrombocytopenia or neutropenia or both that persisted or recurred over the entire period of follow-up in all patients (18 months to 15 years). The disease was associated with splenomegaly in eight patients and lymphadenopathy in nine patients. Boys were affected more frequently than were girls (ratio 11:2). Thrombocytopenia improved temporarily during treatment with corticosteroids, i.v. immunoglobulin G, RhoGAM, and a variety of immunosuppressive agents; however, neutropenia tended to be much more resistant to these therapies. Splenectomy was ineffective in two children in whom the procedure was performed. Platelet of and neutrophil antibodies or both were detected in five of six patients who were tested, suggesting an autoimmune cause for the cytopenias.

Conclusions: These findings suggest that ITN in childhood is distinct from immune thrombocytopenic purpura, particularly in terms of its chronicity and poor response to therapy.

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儿童特发性血小板减少症和中性粒细胞减少症。
目的:1975年至1990年间,在安大略省多伦多儿童医院就诊的13例患者被注意到并发特发性血小板减少症和中性粒细胞减少症(ITN;血小板计数< 150 × 10(9)/L;绝对中性粒细胞计数< 1.5 × 10(9)/L)。这些患者都有正常的骨髓功能,没有全身性疾病的迹象。患者和方法:进行详细的图表回顾,以确定这些患者的临床和实验室特征。结果:虽然这是一组异质性的患者,但他们有几个共同的特征。在所有患者的整个随访期间(18个月至15年),该疾病伴有血小板减少或中性粒细胞减少或两者同时存在或复发的慢性病程。本病伴脾肿大8例,淋巴结肿大9例。男孩比女孩更容易受到影响(比例为11:2)。在皮质类固醇、静脉注射免疫球蛋白G、RhoGAM和各种免疫抑制剂治疗期间,血小板减少症暂时得到改善;然而,中性粒细胞减少症往往对这些治疗更有抵抗力。脾切除术对2例患儿无效。在接受检测的6例患者中,有5例检测到血小板抗体和中性粒细胞抗体,或两者兼有,提示细胞减少的自身免疫性原因。结论:这些发现表明,儿童期ITN不同于免疫性血小板减少性紫癜,特别是在其慢性和治疗反应差方面。
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