research paper

Epidemiology of paediatric immune thrombocytopenia in the

General Practice Research Database

Mellissa Yong,1 Wilma Marieke Summary

Schoonen,2 Lin Li,3 Gena Kanas,4 Jenna
Coalson,4 Fionna Mowat,4 Jon Fryzek1
and James A. Kaye5,6
1
Global Epidemiology, Amgen, Inc., One Amgen
Center Drive, Thousand Oaks, CA, USA,
2
International Epidemiology, Amgen, Ltd., 1
Uxbridge Business Park, Sanderson Road,
Uxbridge, Middlesex, UK, 3Boston Collaborative
Drug Surveillance Program, Boston University
School of Medicine, 11 Muzzey Street, Lexington,
MA, 4Exponent, Inc., 149 Commonwealth Drive,
Menlo Park, CA, 5Epidemiology, RTI Health
Solutions, 1440 Main Street, Waltham, and
6
Boston University School of Public Health, 715
Albany Street, Talbot Building, Boston, MA, USA
Received 22 December 2009; accepted for
publication 22 February 2010
Correspondence: Mellissa Yong, Global
Epidemiology, Amgen Inc., One Amgen Center
Drive, Thousand Oaks, CA 91320, USA.
E-mail: myong@amgen.com
This study assessed the incidence of immune thrombocytopenia (ITP) and
characteristics associated with ITP in the paediatric population using the
General Practice Research Database (GPRD). Two hundred and fifty-seven
paediatric ITP patients were identified out of 1145 incident patients with ITP
recorded between 1990 and 2005. The age-specific incidence for ITP in
paediatric patients was 4Æ2 per 100 000 person-years (PY) [95% confidence
interval (CI): 3Æ7–4Æ8 per 100 000 PY], with a statistically significantly higher
incidence in boys compared to girls aged 2–5 years [9Æ7 (95% CI: 7Æ5–12Æ2)
per 100 000 PY vs. 4Æ7 (95% CI: 3Æ2–6Æ6) per 100 000 PY, respectively]. By
contrast, among teenagers aged 13–17 years, the overall incidence was lower
[2Æ4 (95% CI: 1Æ7–3Æ3) per 100 000 PY] with a similar incidence in girls and
boys. There was a relationship between age and sex with ITP incidence,
suggesting that patterns of disease burden differ among children and
teenagers. Evidence of an infection or immunization shortly before ITP
diagnosis was apparent in 52 (20Æ2%) and 22 (8Æ6%) of the 257 paediatric
ITP patients, respectively. Two deaths were observed during the study period.
ITP is an important although rarely fatal disease in paediatric patients and its
aetiology remains unexplained in the majority of cases.
Keywords: immune thrombocytopenia, incidence, descriptive epidemiology,
General Practice Research Database, children.

Immune thrombocytopenia (ITP) is an acquired immune-
mediated disorder characterized by low blood platelet counts
(<150 · 109/l), or thrombocytopenia (Rodeghiero, 2003). The
course of ITP can be acute, (i.e. spontaneously resolving within
a few months), persistent, (i.e. of 3–12 months duration), or
chronic (i.e. lasting ‡12 months) Rodeghiero, 2009. ITP in
children is usually short-lived, with the onset typically being
acute and frequently occurring a few days or weeks after viral
infection or vaccination (Cines & Blanchette, 2002; Nugent,
2006; Psaila & Bussel, 2007; Le Meignen et al, 2008).
The diagnosis of ITP is made by excluding other causes of
thrombocytopenia. The basic diagnostic approach to ITP
includes a patient history, physical examination, complete
blood count, and examination of a peripheral blood smear
(Provan & Newland, 2002). In children, two-thirds of patients
have been reported to recover within 6 months and to improve
spontaneously with no specific treatment (Kuhne et al, 2001;
Nugent, 2006; Psaila & Bussel, 2007; Glanz et al, 2008). Under-
diagnosis may be particularly common among children as
episodes of ITP tend to be of shorter duration.
It has been suggested that childhood ITP may be a distinct
entity from adult ITP, as a low proportion of paediatric cases
has chronic disease and incidence distribution between genders
is similar among children. This is in contrast to adult ITP,
where the majority of cases has a chronic form of ITP with
more women affected than men (Cines & Blanchette, 2002).
We have previously described the sex- and age-specific
incidence estimates of ITP using the large United Kingdom
(UK) population-based General Practice Research Database
(GPRD) (Schoonen et al, 2009). Here we provide a more
detailed description of the incidence estimates of paediatric
ITP and directly compare these to incidence estimates of adult
ITP from the same database. We also examined prior
infections and immunizations, the platelet count distribution

First published online 04 April 2010

ª 2010 Blackwell Publishing Ltd, British Journal of Haematology, 149, 855–864 doi:10.1111/j.1365-2141.2010.08176.x