Isolated thrombocytopenia uncommon in children treated for ALL [Pediatrics Classics Series]

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1. Among 2239 pediatric patients diagnosed with acute lymphoblastic leukemia, no child met criteria for isolated thrombocytopenia as evidenced by complete blood count, peripheral blood smear, and hepatosplenomegaly on physical exam.

Original Date of Publication: December 1989

Study Rundown: Prior to this study’s publication, children with isolated decreases in platelet counts commonly underwent bone marrow aspiration/biopsy in order to assess for potential leukemia before initiating steroid therapy. As bone marrow examination is an invasive procedure, not without its own risks, this study investigated whether or not this was a necessary practice. Through retrospective analysis of forms prior to the start of a leukemia protocol study, researchers found that none of the 2239 pediatric patients included met criteria for “isolated significant thrombocytopenia” at the time of their leukemia diagnosis. This study is limited by its retrospective nature. Based on this research, investigators concluded that with confirmation of these findings by additional prospective studies, children presenting with likely idiopathic thrombocytopenic purpura (ITP) do not require referral for bone marrow examination. Now, as a result of such studies, children with clear ITP do not undergo bone marrow aspiration and instead are placed on steroid therapy or intravenous immunoglobulin without workup beyond complete blood count (CBC) and physical exam.

Click to read the study in Pediatrics

In-Depth [retrospective cohort study]: Institutions participating in 2 Pediatric Oncology Group acute lymphoblastic leukemia protocols for patients provided prestudy forms from 2239 children with information including the CBC and differential and the presence of hepatosplenomegaly for each patient. The number of patients diagnosed with acute lymphoblastic leukemia and with “isolated significant thrombocytopenia” prior to treatment initiation was then recorded. Isolated thromobocytopenia was defined as a platelet count < 50,000/mm³ without blast cells seen on peripheral blood smear, hemoglobin > 11 g/dL, an absolute neutrophil count (ANC) > 1500/mm³, and no hepatosplenomegaly on physical examination. No children in the study diagnosed with ALL met criteria for “isolated significant thrombocytopenia.”

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