High-sensitivity C-Reactive Protein Levels at Presentation and its Association with Platelet Recovery in Newly Diagnosed Immune Thrombocytopenia in Children

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.