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Laporan kasus: perdarahan subkonjungtiva dan multipel hematoma ektremitas pada anak yang baru didiagnosis immune thrombocytopenic purpura (ITP)

Abstract

Introduction: Immune thrombocytopenic purpura (ITP) is an acquired autoimmune haematological condition characterized by thrombocytopenia (platelet count less than 100×10^9/L) with normal bone marrow. The estimated incidence of ITP in children is 1.9 to 6.4 cases per 100,000/year. Manifestations can range from severe acute bleeding in the mucocutaneous region or could be gradual. Considering rarity of reported ITP cases in children, the author aims to present findings from a case in paediatric patients with clinical presentations of subconjunctival haemorrhage and multiple hematomas on the extremities, and frequent relapses during conventional treatment.

Case report: A 2-year-old boy was referred from a primary health centre to the Emergency Department (ED) of RSUDS with a two-day history of fever. He also had a history of back and leg bruising since one week ago, history of nose-bleeding 3 days ago, and redness on his left eye since this morning of admission. Physical examination showed subconjunctival bleeding in the left eye and a hematoma on the left leg. Laboratory tests showed thrombocytopenia, leucocytosis, and microcytic hypochromic anaemia. Blood smear examination showed thrombocytopenia, giant platelets, normochromic anaemia with poikilocytosis, and leucocytosis. The patient was treated with empirical antibiotics, methylprednisolone, platelet transfusions, and antipyretics, and was discharged after 5 days of treatment.

Conclusion: The diagnosis of ITP can be confirmed through history taking, physical examination, and laboratory investigations.

 

Pendahuluan: Immune thrombocytopenic purpura (ITP) adalah suatu gangguan hematologi berupa kondisi autoimun yang didapat dan ditandai oleh trombositopenia (kurang dari 100×109/L), dengan sumsum tulang normal. Insiden perkiraan ITP pada anak adalah 1,9 hingga 6,4 kasus per 100.000/tahun. Manifestasi dapat berupa pendarahan akut yang parah di mukokutaneus atau bersifat perlahan. Mengingat sedikitnya kasus ITP yang dilaporkan pada anak, penulis tertarik membagikan temuan kasus ITP pada pasien anak dengan presentasi klinis berupa perdarahan subkonjungtiva dan multipel hematoma pada ekstremitas, serta sering relaps selama pengobatan konvensional.

Laporan Kasus: Anak laki-laki usia 2 tahun 10 bulan rujukan dari Puskesmas datang ke IGD RSUDS dengan keluhan demam sejak dua hari sebelum masuk rumah sakit, lebam pada punggung dan kaki sejak 1 minggu sebelum masuk rumah sakit, riwayat mimisan 3 hari sebelum pemeriksaan, dan mata kiri merah sejak saat pagi hari sebelum pemeriksaan. Hasil pemeriksaan fisik menunjukkan subconjunctiva bleeding pada mata kiri dan hematoma pada regio cruris kiri. Hasil pemeriksaan darah lengkap menunjukkan trombositopenia. Leukositosis, dan anemia hipokromik mikrositik dan hasil blood smear menunjukkan trombositopenia, giant platelet, anemia normokromik poikilositosis, dan leukositosis. Pasien didiagnosis dengan Immune Thrombocytopenic Purpura. Setelah diberikan terapi berupa antibiotic empiris, methylprednisolone, transfusi TC, dan antipiretik pasien diperbolehkan pulang setelah perawatan selama 5 hari.

Kesimpulan: Immune thrombocytopenic purpura (ITP) dapat ditegakkan melalui anamnesis, pemeriksaan fisik dan pemeriksaan penunjang.

References

  1. Tărniceriu CC, Hurjui LL, Florea ID, et al. Immune Thrombocytopenic Purpura as a Hemorrhagic Versus Thrombotic Disease: An Updated Insight into Pathophysiological Mechanisms. Med. 2022;58(211):1-19. doi:10.3390/medicina58020211
  2. Vaillant AAJ, Gupta N. ITP-Immune Thrombocytopenic Purpura. StatPearls Publishing; 2023. https://www.ncbi.nlm.nih.gov/books/NBK537240/#
  3. Zitek T, Weber L, Pinzon D, Warren N. Assessment and Management of Immune Thrombocytopenia (ITP) in the Emergency Department: Current Perspectives. Open Access Emerg Med. 2022;14:25-34. doi:10.2147/OAEM.S331675
  4. Chen ZY, Oswald BE, Sullivan JA, et al. Platelet physiology and immunology: pathogenesis and treatment of classical and non-classical fetal and neonatal alloimmune thrombocytopenia. Ann Blood. 2019;4(29):1-19. doi:10.21037/aob.2019.12.04
  5. McLeish R, Boyd D. Immune thrombocytopenic purpura: A case report. Adv Oral Maxillofac Surg. 2022;8(100340):1-2. doi:10.1016/j.adoms.2022.100340
  6. Audia S, Mahevas M, Nivet M, Ouandji S, Ciudad M, Bonnotte B. Immune Thrombocytopenia: Recent Advances in Pathogenesis and Treatments. HemaSphere. 2021;5(6):1-9. doi:10.1097/HS9.0000000000000574
  7. Matzdorff A, Alesci SR, Gebhart J, et al. Expert Report on Immune Thrombocytopenia: Current Diagnostics and Treatment - Recommendations from an Expert Group from Austria, Germany, and Switzerland. Oncol Res Treat. 2023;46(2):5-44. doi:10.1159/000529662
  8. Neunert C, Terrell DR, Arnold DM, et al. American Society of Hematology 2019 guidelines for immune thrombocytopenia. Blood Adv. 2019;3(23):3829-3866. doi:10.1182/bloodadvances.2019000966
  9. Neunert C, Vesely SK, Mithoowani S, Kim T. Management of Immune Thrombocytopenia (ITP). American Society of Hematology; 2019.
  10. Kim TO, Despotovic JM. Pediatric immune thrombocytopenia (ITP) treatment. Ann Blood. 2021;6(4):1-13. doi:10.21037/aob-20-96
  11. Thakre R, Gharde P, Raghuwanshi M. Idiopathic Thrombocytopenic Purpura : Current Limitations and Management. Cureus. 2023;15(11):1-10. doi:10.7759/cureus.49313
  12. Lee JM. Advances in management of pediatric chronic immune thrombocytopenia: a narrative review. J Yeungnam Med Sci. 2023;40(3):241-246. doi:10.12701/jyms.2022.00745
  13. Grace RF, Lambert MP. An update on pediatric ITP: differentiating primary ITP, IPD, and PID. Blood. 2022;140(6):542-555. doi:10.1182/blood.2020006480
  14. Provan D, Arnold DM, Bussel JB, et al. Updated international consensus report on the investigation and management of primary immune thrombocytopenia. Blood Adv. 2019;3(22):3780-3817. doi:10.1182/bloodadvances.2019000812
  15. Matzdorff A, Meyer O, Ostermann H, et al. Immune Thrombocytopenia - Current Diagnostics and Therapy: Recommendations of a Joint Working Group of DGHO, ÖGHO, SGH, GPOH, and DGTI. Oncol Res Treat. 2018;41(5):1-30. doi:10.1159/000492187
  16. Mahendra C. Newly Diagnosed Primary Immune Thrombocytopenia in Children: Which Guideline to Adhere? Scr SCORE Sci Med J. 2021;3(1):92-99. doi:10.32734/scripta.v3i1.4561
  17. Santoshi RK, Patel R, Patel NS, Bansro V, Chhabra G. A Comprehensive Review of Thrombocytopenia With a Spotlight on Intensive Care Patients. Cureus. 2022;14(8):1-17. doi:10.7759/cureus.27718
  18. Witkowski M, Witkowska M, Robak T. Autoimmune thrombocytopenia: Current treatment options in adults with a focus on novel drugs. Eur J Haematol. 2019;103(6):531-541. doi:10.1111/ejh.13319
  19. Almizraq RJ, Branch DR. Efficacy and mechanism of intravenous immunoglobulin treatment for immune thrombocytopenia in adults. Ann Blood. 2021;6(2):1-20. doi:10.21037/aob-20-87
  20. Pietras NM, Pearson-Shaver AL. Immune Thrombocytopenic Purpura. StatPearls Publishing; 2022. doi:10.14238/sp20.1.2018.58-64
  21. Raadsen M, du Toit J, Langerak T, van Bussel B, van Gorp E, Goeijenbier M. Thrombocytopenia in virus infections. J Clin Med. 2021;10(877):1-33. doi:10.3390/jcm10040877
  22. Li C, Li J, Ni H. Crosstalk Between Platelets and Microbial Pathogens. Front Immunol. 2020;11(1962):1-14. doi:10.3389/fimmu.2020.01962
  23. Lee A, Hong J, Chung H, et al. Helicobacter pylori eradication affects platelet count recovery in immune thrombocytopenia. Sci Rep. 2020;10(1):1-8. doi:10.1038/s41598-020-66460-5
  24. Takeuchi H, Okamoto A. Helicobacter pylori Infection and Chronic Immune Thrombocytopenia. J Clin Med. 2022;11(4822):1-8. doi:10.3390/jcm11164822
  25. Vianelli N, Auteri G, Buccisano F, et al. Refractory primary immune thrombocytopenia (ITP): current clinical challenges and therapeutic perspectives. Ann Hematol. 2022;101(5):963-978. doi:10.1007/s00277-022-04786-y
  26. Pulanić D, Bátorová A, Bodó I, et al. Use of thrombopoietin receptor agonists in adults with immune thrombocytopenia: a systematic review and Central European expert consensus. Ann Hematol. 2023;102(4):715-727. doi:10.1007/s00277-023-05114-8
  27. Kuter DJ. The treatment of immune thrombocytopenia (ITP)-focus on thrombopoietin receptor agonists. Ann Blood. 2021;6(7):1-21. doi:10.21037/aob-21-23
  28. Hui D, Barbara A, McGill SC. Guidelines for Pediatric Immune Thrombocytopenia. Can J Heal Technol. 2022;2(6):1-33. doi:10.51731/cjht.2022.348
  29. Cheng CN, Yang YN, Yeh YH, Chen LW, Chen JS, Lin YC. Predictors of Remission in Severe Childhood Immune Thrombocytopenia. Diagnostics. 2023;13(341):1-12. doi:10.3390/diagnostics13030341
  30. Ariawati K, Setiyawan IMK. Platelets level response after three days therapy in children with acute Immune Thrombocytopenic Purpura (ITP): a 10 years’ experience at the tertiary hospital. Bali Med J. [Internet]. 2019 Dec. 1 [cited 2024 Feb. 26];8(3):897-901

How to Cite

Komang Manik Kencana Dewi, & Windiyanto, R. . (2024). Laporan kasus: perdarahan subkonjungtiva dan multipel hematoma ektremitas pada anak yang baru didiagnosis immune thrombocytopenic purpura (ITP). Intisari Sains Medis, 15(1), 294–303. https://doi.org/10.15562/ism.v15i1.1974

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Komang Manik Kencana Dewi
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Romy Windiyanto
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