Age and Duration of Bleeding Symptoms at Diagnosis Best Predict Resolution of Childhood Immune Thrombocytopenia at 3, 6, and 12 Months

Revel‐Vilk, Shoshana; Yacobovich, Joanne; Frank, Shlomzion; Ben-Ami, Tal; Yechieli, Michal; Shkalim, Vered; Lebel, Asaf; Oz, Rotem Semo; Tamary, Hannah

doi:10.1016/j.jpeds.2013.06.018

Cited by 35 publications

(47 citation statements)

References 22 publications

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“…The recovery rate for children aged less than 5 years and with abrupt onset was 91.1% compared with 53.3% for the group aged 5 years or above with nonabrupt onset. Our power to predict disease resolution was thus about 90%, which is comparable to that of the study by Revel‐Vilk et al . Additionally, children with a 4‐week postdiagnosis platelet level at least 100 × 10 9 l –1 had a higher likelihood of disease resolution (OR: 8.6, 95% CI: 5.0–14.8) when compared with children with a 4‐week postdiagnosis platelet level less than 100 × 10 9 l –1 .…”

Section: Discussionsupporting

confidence: 84%

“…One systematic review showed that children who received the combination treatment of IVIG and methylprednisolone had a greater risk of chronic ITP (OR: 2.67, 95% CI: 1.44–4.96), and children who received IVIG treatment alone developed chronic ITP less often than children treated with other regimens (OR: 0.39, 95% CI: 0.28–0.54). [4] ITP treatment options are still controversial in terms of disease resolution . However, at this moment, there are no large studies available reporting the true incidence of chronic ITP in patients who were only observed, or who received steroid or IVIG alone, or a combined IVIG–steroid treatment.…”

Section: Treatmentmentioning

confidence: 99%

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Predictive factors for resolution of childhood immune thrombocytopenia: Experience from a single tertiary center in Thailand

Chotsampancharoen

Sripornsawan

Duangchoo

et al. 2016

Pediatric Blood & Cancer

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Section: Discussionsupporting

confidence: 84%

Section: Treatmentmentioning

confidence: 99%

Predictive factors for resolution of childhood immune thrombocytopenia: Experience from a single tertiary center in Thailand

Chotsampancharoen

Sripornsawan

Duangchoo

et al. 2016

Pediatric Blood & Cancer

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“…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. 65 Finally, Yacobovich et al recently published a narrative review of several clinical, therapeutic, and genetic predictors for recovery of childhood ITP. 66 However, neither of these studies performed an extensive literature search, and results were not systematically reviewed.…”

Section: Discussionmentioning

confidence: 99%

“…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. 65 Finally, Yacobovich et al recently published a narrative 3302 HEITINK-POLLÉ et al BLOOD, 20 NOVEMBER 2014 x VOLUME 124, NUMBER 22 For personal use only. on May 7, 2018. by guest www.bloodjournal.org From review of several clinical, therapeutic, and genetic predictors for recovery of childhood ITP.…”

mentioning

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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“…Although 50-70% of children with acute ITP achieve complete remission with or without treatment (Kuhne et al, 2003;Rosthoj et al, 2003), only a minority of untreated adult patients with chronic ITP achieve remission (Stasi et al, 1995). Younger children with abrupt onset of bleeding are more likely to recover spontaneously (Revel-Vilk et al, 2013).…”

Section: Disease Coursementioning

confidence: 99%

Immune Thrombocytopenia☆

Pant¹,

Acharya²,

Bhatt³

et al. 2014

Reference Module in Biomedical Sciences

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Age and Duration of Bleeding Symptoms at Diagnosis Best Predict Resolution of Childhood Immune Thrombocytopenia at 3, 6, and 12 Months

Cited by 35 publications

References 22 publications

Predictive factors for resolution of childhood immune thrombocytopenia: Experience from a single tertiary center in Thailand

Predictive factors for resolution of childhood immune thrombocytopenia: Experience from a single tertiary center in Thailand

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

Immune Thrombocytopenia☆

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