Association of Immune Thrombocytopenia and Inflammatory Bowel Disease in Children

Abstract

Background: The association between inflammatory bowel disease (IBD) and immune thrombocytopenia (ITP) is still uncertain. In this multicenter retrospective study, the coexistence of both diseases was investigated in children diagnosed from 1 January 2000 to 31 December 2019. Methods: Clinical characteristics of both IBD and ITP, onset of disorders, and patient’s response to treatment were collected through a structured form sent to 55 Italian pediatric referring centers for hematological disorders. Result: Centers responded to the survey and reported the coexistence of IBD and ITP in 14 children. The first diagnosis was ITP in 57.1% and IBD in 35.7% of patients: it was simultaneous in 7.1%. IBD was classified as ulcerative colitis (57.1%), Crohn disease (35.7%), and unclassified (7.1%). No therapy for IBD other than steroids had any effect on ITP course. Colectomy resulted in recovery from ITP in 1 of the 2 patients surgically treated. ITP was always mild but turned to be chronic in half of patients. Conclusions: In all patients, ITP was mild without any evident impact on IBD severity, but the incidence of chronic ITP seems to be higher than what is usually observed in the pediatric age group. Colectomy had unpredictable effects on ITP.

Garlic (Allium sativum L.) as an Ally in the Treatment of Inflammatory Bowel Diseases

“…The higher incidence of ITP in childhood rather than in adulthood leads us to move away from the hypothesis that ITP is a consequence of IBD. However, this hypothesis, as demonstrated by Guarina et al (2021), cannot be excluded since, in pediatric patients, there was complete recovery from ITP after undergoing colectomy [56]. In other patients, a combination of IBD exacerbation and lowering of the platelet count was observed.…”

“…Another important consideration is that several antibody-induced autoimmune hematologic diseases, such as immune thrombocytopenia (ITP), characterized by platelet destruction by antibodies, have occasionally been observed in patients with IBD [56]. In fact, more and more scientists are conducting studies in order to understand the correlation of these two diseases.…”

Resolved Hypereosinophilic Syndrome and Immune Thrombocytopenic Purpura in Ulcerative Colitis Patients Post Colectomy: A Case Series and Literature Review

“…Journal of Inflammation Research 2022:15 6376 reported to be of therapeutic benefit in children with UC comorbid with ITP. 37 In Guarina et al 37 's case series of eight children with comorbid UC and ITP, two cases underwent colectomy and the ITP recovered postoperatively in one of them.…”

“…In this article, we presented two cases of two comorbidities (HES and ITP) occurring in the context of chronic active UC and responding only to surgical colectomy. Though several cases of HES 18,[25][26][27][28] and ITP 14,23,[29][30][31][32][33][34][35][36][37][38][39] have been reported to co-occur with UC, the patients described in this article are unique in their presentation and treatment response. To the best of our knowledge, they represent rare cases of refractory comorbidities in the context of UC that failed conventional medical therapy and responded only to surgical treatment.…”

“…Concomitant occurrence of ITP and UC is rare. 14,23,[29][30][31][32][33][34][35][36][37][38][39] In patients with UC, ITP represents an extraintestinal manifestation of the disease mediated by immune-mediated mechanisms. 29 The differential diagnosis of thrombocytopenia is broad.…”