Pb2620: nighttime symptoms are associated with fatigue among children and adolescents with chronic itp: data from the itp natural history study registry

Topic: 32. Platelet disorders Background: Immune thrombocytopenia (ITP) is an autoimmune bleeding disorder associated with poor quality of life and fatigue. However, the factors that influence fatigue in ITP are unknown. Particularly, limited information exists on how pediatric populations experience fatigue. Understanding factors that cause fatigue may help identify ways to address this, oftentimes, non-visible symptom in ITP. Aims: To compare factors that may influence fatigue, such as bedtime sadness, pain, and anxiety, in children (age 1-12) and adolescents (13-18) with ITP using prospective registry data. Methods: The ITP Natural History Study is a patient consented and completed web-based registry. Forty-four pediatric participants were enrolled through November 2022. Survey responses capturing fatigue and nighttime experiences were based on in the prior seven days, while ITP treatment was based on use in the last six months. Surveys were completed by caregivers with input from patients <18 years. Data analysis was performed using Pearson Chi-square and Fisher exact tests. Results: The registry included 28 children and 16 adolescents, most of whom were male (61%, 27/44) and from the United States (86%, 38/44). Thirty-three reported their date of diagnosis, and all had chronic ITP, with 73% (24/33) with ITP for >2 years. Most children (71.4% (20/28)) and adolescents (75% (12/16) reported feeling ‘tired easily’. More adolescents (50% (8/16) vs. 22% (6/27) in children) reported worry when going to bed (p=0.06). A greater proportion of adolescents also reported they ‘could not stop feeling sad’ (25% (4/16) vs. 11.5% (3/36)) and felt pain at bedtime (42.9% (6/14) vs. 22.2% (4/18)) compared to children. When participants were grouped and stratified based on use of ITP medication, sadness, pain, and anxiety at bedtime were all less frequent among participants receiving ITP-directed medication (52%, 40%, and 41%, respectively) compared with those observed without medication (59%, 64%, and 59%, respectively). When stratified by age, sadness, pain, and anxiety were less frequently reported in adolescents on ITP-directed medication (45%, 25%, and 40%, respectively) than those observed (80%, 100%, and 80%, respectively). This trend was less clear in children on ITP-directed medication (43%, 38%, and 53%, respectively) compared to those observed (45%, 50%, and 50%, respectively). Summary/Conclusion: Adolescents and children with ITP reported sadness, pain, and anxiety at bedtime, which may play an important role in ITP-associated fatigue. These nighttime symptoms were less frequent among those receiving ITP-directed medication compared to those observed without medication. Interestingly, differences in nighttime symptoms were found between children and adolescents, suggesting that pediatric patients may benefit from unique clinical management depending on their age. Study results are limited in statistical significance likely due to a small sample size. Other limitations include possible bias from patient centered responses. Keywords: Quality of life, Immune thrombocytopenia (ITP), Fatigue, Pediatric