Study of assessment of the relation between hypovitaminosis D and clinical presentation of Immune Thrombocytopenia in children

Background Vitamin D (VD) nowadays has been known for its immunomodulatory functions. Immune thrombocytopenia (ITP) is a heterogeneous disease that may be idiopathic or secondary as an outcome of an immune-mediated reaction, hence it is expected that VD may affect the clinical presentation of ITP. Aim The study aims to assess the relationship between hypovitaminosis D and the clinical presentation of ITP, which was determined by using the SMOG bleeding score at the time of ITP diagnosis in children. Patients and methods This case–control study included 75 patients with newly diagnosed ITP and 20 children who were healthy, age and sex-matched, as a control group. Thorough history taking with special attention to the history of drug intake known to cause thrombocytopenia and symptoms suggesting preceding viral infections and complete physical examination for signs of ITP were done for all patients. Evaluation of serum 25(OH)D levels was performed, and the patients and the control group were compared. Results The present study has a median age of 4.00 years, with dominance of skin manifestations followed by mucosa and then organ bleeding as assessed using SMOG Score ITP BAT. Viral infection preceded 74.7% of cases, which had a significant relation with the outcome of ITP, revealing that 79.71% of them became acute. Hypovitaminosis D and insufficiency were found in 12 and 68% of patients, respectively. On the other hand, controls showed 95% with sufficient serum 25(OH)D level and 5% only with insufficiency. Serum VD levels were not statistically different among different levels of platelets count, it was significantly lower in patients with grade I and II mucosal affection compared with patients with no mucosal affection. It was also statistically significantly lower in patients who underwent bone marrow aspiration. Conclusion VD deficiency is associated with Pediatric ITP; thus, correction of VD insufficiency among the pediatric age group through nutritional and/or medical supplementations is recommended since it boosts their immune system, and plays a role in ITP pathophysiology through immunomodulation of its pathogenesis.