A clinical score predicting a brief and uneventful course of newly diagnosed idiopathic trombocytopenic purpura in children

Edslev, Pernille Wendtland; Rosthøj, Steen; Treutiger, Iris; Rajantie, Jukka; Zeller, Bernward; Jónsson, Òlafur G.

doi:10.1111/j.1365-2141.2007.06682.x

Cited by 55 publications

(67 citation statements)

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“…The recent report by Granz et al [16] demonstrated that patients with older age, absence of mucosal bleeding, absence of acute illness before diagnosis, and initial platelet counts[20,000/lL are at risk for developing chronic ITP. The scoring system to predict the development of chronic ITP presents the following variables, although they are weighted differently from one another; abrupt onset, age \10 years, preceding infection, initial platelet count \50,000/lL, wet purpura, and male gender [17].…”

Section: Discussionmentioning

confidence: 99%

Characterization of chronic idiopathic thrombocytopenic purpura in Japanese children: a retrospective multi-center study

et al. 2010

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The objectives of this study are to clarify (1) the difference in demographic and clinical variables at initial presentation between acute and chronic idiopathic thrombocytopenic purpura (ITP), and (2) the prognostic factors of patients with chronic ITP. We conducted a retrospective analysis of 247 children with newly diagnosed ITP between April 1991 and March 2006 who visited one of the 12 hospitals belonging to the Kyoto University Pediatric Hematologic Study Group. 180 and 67 cases were classified as the acute type and as the chronic type, respectively. Older age, higher initial platelet count, positive medical history or concomitant medical diagnosis, the absence of preceding infection or vaccination, and the absence of an increase in immunoglobulin were risk factors for the chronicity. The prognostic factors in chronic ITP were evaluated in 53 patients after excluding patients receiving splenectomy or having insufficient follow-up data. The overall time required for 50% resolution in patients with chronic ITP was approximately 5.6 years. Age at presentation of less than 3 years and higher platelet counts at the time of chronic ITP diagnosis were good prognostic factors. On the other hand, gender, initial platelet counts, and preceding infection or vaccination were not associated with the prognosis.

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Section: Discussionmentioning

confidence: 99%

Characterization of chronic idiopathic thrombocytopenic purpura in Japanese children: a retrospective multi-center study

et al. 2010

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“…The Nordic Society of Pediatric Haematology and Oncology (NOPHO) ITP Working group developed a predicting score for prolonged duration of ITP, based on their Nordic ITP study data, that contains the age at onset of disease, duration of symptoms, preceding infection, gender, platelet count at diagnosis, and the presence of wet purpura. 63 Donato et al validated this score in a cohort of children presenting with ITP in Argentina. 64 Revel-Vilk at al published a simple prediction score based on retrospective data of 472 children that included age and duration of bleeding symptoms at diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Clinical and laboratory predictors of chronic immune thrombocytopenia in children: a systematic review and meta-analysis

Heitink‐Pollé

Nijsten

Boonacker

et al. 2014

Blood

131

124

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Key Points• Older age, insidious onset, no preceding infection, mild bleeding, and higher platelet count are the strongest risk factors for chronic ITP.• Intravenous immunoglobulin treatment seems to protect against development of chronic ITP.Childhood immune thrombocytopenia (ITP) is a rare autoimmune bleeding disorder. Most children recover within 6 to 12 months, but individual course is difficult to predict. We performed a systematic review and meta-analysis to identify predictors of chronic ITP. We found 1399 articles; after critical appraisal, 54 studies were included. The following predictors of chronic ITP in children, assessed in at least 3 studies, have been identified: female gender (odds ratio [OR] 1.17, 95% confidence interval [CI] 1.04-1.31), older age at presentation (age ‡11 years; OR 2.47, 95% CI 1.94-3.15), no preceding infection or vaccination (OR 3.08,, insidious onset (OR 11.27,), higher platelet counts at presentation ( ‡20 3 10 9 /L: OR 2.15, 95% CI 1.63-2.83), presence of antinuclear antibodies (OR 2.87, 95% 1.57-5.24), and treatment with a combination of methylprednisolone and intravenous immunoglobulin (OR 2.67, 95% CI 1. 44-4.96). Children with mucosal bleeding at diagnosis or treatment with intravenous immunoglobulin alone developed chronic ITP less often (OR 0.39, 95% CI 0.28-0.54 and OR 0.71, 95% CI 0.52-0.97, respectively). The protective effect of intravenous immunoglobulin is remarkable and needs confirmation in prospective randomized trials as well as future laboratory studies to elucidate the mechanism of this effect. (Blood. 2014;124(22):3295-3307) IntroductionChildhood immune thrombocytopenia (ITP) is a rare autoimmune disorder characterized by isolated thrombocytopenia (peripheral blood platelet count ,100 3 10 9 /L) in the absence of other causes that may be associated with thrombocytopenia.1 Most children present with a typical history of acute development of purpura and bruising, often after a mild viral infection. Management of newly diagnosed ITP consists of careful observation, regardless of platelet count. Severe bleeding, occurring in only 3% to 5% of children, 2 requires treatment with corticosteroids, intravenous immunoglobulin (IVIg), or anti-Rhesus-D immunoglobulin, either alone or in combination and, if life threatening, also with platelet and red blood cell transfusions. 3,4 Chronic ITP is currently defined as thrombocytopenia ,100 3 10 9 /L lasting for .12 months.1 About 20% to 25% of children with newly diagnosed ITP will develop chronic disease. Because of the high impact of ITP on a child's everyday life and activities, as well as to decide whether treatment has to be instituted to influence the clinical course of ITP, it is of clinical significance if the course of the disease could be predicted at time of diagnosis.Several clinical, therapeutic, laboratory, and genetic predictors of chronic ITP have been evaluated in children.5-7 A systematic review or meta-analysis, however, has not yet been performed. In this study, we systematically analyzed all...

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“…The countries in North Europe suggested a scoring system by showing that problematic bleedings occured more frequently in patients with a thrombocytopenia lasting more than 3 months and with a thrombocyte count of <20000/mm 3 : this scoring system was based on 6 clinical findings including sudden onset (5), age<10 years (3), presence of previous infection (2), thrombocyte count < 5 x 10(9)/l, wet purpura (1) and male gender (1). High scores determine low risk (30). In immune (idiopathic) thrombocytopenic purpura, the most frightening finding is intracranial bleeding (ICB) which leads to administration of treatment (1,23), because morbidity with a rate of up to 50% is reported in children with ITP in addition to mortality.…”

Section: Treatment Of Acute Childhood Itpmentioning

confidence: 99%

2011 yılında çocukluk çağı immün trombositopenik purpura hastalığı izlem ve tedavisinde değişiklikler

Çelkan¹

2012

tpa

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Immune thrombocytopenic purpura (ITP) is the most frequent hemorrhagic disease in children. The shortened life of platelets because of immunologic damage (antibodies absorbed by platelets) and insufficient compensatory increased function of the bone marrow result in reduced number of platelets in the peripheral blood. There are three forms of ITP: acute, chronic and persistent. The acute form occurs in 80-90% of cases with bleeding episodes lasting a few days or weeks, but no longer than 6 months. The new 2011 ASH guideline increased this period to one year. It is typical for the phenomenon of bleeding that it starts suddenly and without any other sign of illness. The most frequent acute form appears between the second and fourth year and it usually occurs after acute viral infections. Children older than 10 years of age, like adults, often have the chronic form associated with other immunologic disorders. Hemorrhagic manifestations include: petechiae, purpura, epistaxis, gastrointestinal and genitourinary bleeding. They depend on the grade of thrombocytopenia, although there is no strict correlation between the number of platelets and volume of bleeding. In cases of acute ITP in children, usually there are two therapeutic options or therapies of choice: corticosteroids and high doses of intravenous immunoglobulin. There are also immunosupressive therapy, anti Rh(D) immunoglobulin, cyclosporine, cytostatics, danazol, rituximab, and TPO receptor agonists. In cases of distinctive hemorrhagic syndrome, there are also indications for platelet transfusion. Nowadays splenectomy is more restricted, because one third of cases are unsuccessful. (Turk Arch Ped 2012; 47: 8-17)

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A clinical score predicting a brief and uneventful course of newly diagnosed idiopathic trombocytopenic purpura in children

Cited by 55 publications

References 10 publications

Characterization of chronic idiopathic thrombocytopenic purpura in Japanese children: a retrospective multi-center study

Characterization of chronic idiopathic thrombocytopenic purpura in Japanese children: a retrospective multi-center study

Clinical and laboratory predictors of chronic immune thrombocytopenia in children: a systematic review and meta-analysis

2011 yılında çocukluk çağı immün trombositopenik purpura hastalığı izlem ve tedavisinde değişiklikler

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