Guidelines for the investigation and management of idiopathic thrombocytopenic purpura in adults, children and in pregnancy

Provan, Drew; Newland, Adrian C.; Norfolk, D. R.; Bolton‐Maggs, Paula; Lilleyman, J S; Greer, Ian A.; May, A.E.; Murphy, M. F.; Ouwehand, Willem H.; Watson, Shirley; Bcs., Haematology

doi:10.1046/j.1365-2141.2003.04131.x

Cited by 696 publications

(117 citation statements)

References 183 publications

(234 reference statements)

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“…persistent thrombocytopenia (platelet count <100 × 10 9 /l; normal range of platelet count in the Chinese is 100–300 × 10 9 /l) for at least 6 months, absent hepatosplenomegaly and lymphadenopathy, normal or increased numbers of megakaryocytes in bone marrow aspirates, negative antinuclear antibody and HIV serological test, and absence of underlying conditions such as systemic lupus erythematosus, lymphoproliferative disorders, and congenital or hereditary thrombocytopenia. The indication for splenectomy was in agreement with the published guidelines [9,10,11], i.e. patients (>4 years old) with severe thrombocytopenia persistent for at least 6 months who did not respond to steroids or who relapsed during steroid tapering.…”

Section: Methodssupporting

confidence: 51%

Splenectomy for Chronic Idiopathic Thrombocytopenic Purpura in Children: A Single Center Study in China

Wang¹,

et al. 2006

Acta Haematol

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The management of chronic and refractory idiopathic thrombocytopenic purpura (ITP) in children is controversial. We conducted a retrospective review of our single center experience in China between 1990 and 2003 with splenectomy for chronic ITP in children in order to determine the initial and long-term hematological response, morbidity, mortality, predictors of response to splenectomy and the therapy in children who failed splenectomy. Of 65 children analyzed, the overall immediate clinical response to splenectomy was 89.2%. The median postsplenectomy follow-up time was 52 months (8–124). During follow-up, 9 children (13.8%) relapsed within a median time of 6 months (2–58). The overall morbidity was 1.5% and perioperative mortality was zero. During follow-up, 1 child died of intracranial hemorrhage (ICH) and 1 died of overwhelming postsplenectomy infection (OPSI). The platelet count at day 7 after splenectomy was a predictor of a sustained response to splenectomy but no preoperative parameters were predictors of the response to splenectomy. Of the 15 children who failed splenectomy, excluding the one who died of ICH, only 2 children intermittently required corticosteroids and IVIG. Splenectomy is a potential therapy to provide long-term control of disease in children with chronic ITP and is associated with low morbidity and mortality. The risk of fulminant sepsis remains an omnipresent concern. Antipneumococcal vaccination and antibiotic prophylaxis should be recommended and children should receive timely and adequate antibiotics for bacteria infection to lessen the problem of OPSI.

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Section: Methodssupporting

confidence: 51%

Splenectomy for Chronic Idiopathic Thrombocytopenic Purpura in Children: A Single Center Study in China

Wang¹,

et al. 2006

Acta Haematol

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“…The clinical symptoms at presentation were also consistent with the literature [3, 10, 17, 21, 22,24,25,26]; petechiae and ecchymoses were overall the most frequent signs, oral haemorrhages and epistaxis predominated among the mucosal symptoms. More serious haemorrhages (melaena, haematuria, menorrhagia) are reported in less than 4% of cases, similar to other observations [3, 17], but physicians did not put patients with these symptoms in the life-threatening category (type C). The only patient classified as type C presented profound epistaxis, oral and retinal haemorrhages, and an initial platelet count of <5 × 10 9 /l.…”

Section: Discussionsupporting

confidence: 76%

“…Referring to the secondary objectives of our study, data concerning sex, age and platelet count at diagnosis were similar to other case series [3, 10, 17,21,22,23,24]; however, other authors report that there are more boys among younger children with ITP [25]. The clinical symptoms at presentation were also consistent with the literature [3, 10, 17, 21, 22,24,25,26]; petechiae and ecchymoses were overall the most frequent signs, oral haemorrhages and epistaxis predominated among the mucosal symptoms.…”

Section: Discussionmentioning

confidence: 65%

“…More recent data report a lower hospitalization rate, and the common practice is to avoid hospitalization until it is actually necessary [3, 8, 9, 12]. However, no controlled studies have evaluated the real effectiveness of hospitalization [15], and all published guidelines provide different instructions.…”

Section: Discussionmentioning

confidence: 99%

“…Several haematology societies have published guidelines for acute ITP management in childhood [2,3,4,5]. These guidelines vary, as does also their implementation in clinical practice [6,7,8,9,10,11,12].…”

Section: Discussionmentioning

confidence: 99%

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Management of Acute Childhood Idiopathic Thrombocytopenic Purpura according to AIEOP Consensus Guidelines: Assessment of Italian Experience

et al. 2008

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Background: Consensus guidelines for diagnosis and treatment of acute childhood idiopathic thrombocytopenic purpura (ITP) were published in 2000 by the Italian Association of Pediatric Haematology and Oncology (AIEOP). The assessment of guideline implementation was the primary objective of the present study. Patients and Methods: Information on each newly diagnosed case of ITP referring to centres conforming with the guidelines was obtained by a questionnaire. Results: Data concerning 609 new cases of acute childhood ITP were collected including 346 (56.8%) asymptomatic-paucisymptomatic forms (type A), 262 (43%) intermediate clinical forms (type B), and 1 (0.2%) severe form (type C). At diagnosis, 82% of cases were hospitalized. Age, platelet count and duration of hospitalization were significantly different in type A and type B cases. Of the total number of cases, 25% were kept under observation, 38.6% received intravenous immunoglobulins, 23.9% oral or parenteral steroids, and 12.7% other treatments. The initial treatment turned out to be appropriate for 428 cases (72.2%), of uncertain appropriateness in 71 (11.9%), and inappropriate in 95 cases (15.9%). The total level of implementation was 84.1%. Conclusions: A high rate of guideline implementation was observed during the study period. The guidelines should be reviewed taking into account more recent evidence.

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What Is New Related to Helicobacter pylori Infection in Children and Teenagers?

Kato

Sherman²

2005

Arch Pediatr Adolesc Med

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Helicobacter pylori infection is a common bacterial infection for humans, and the organism is the most prevalent gastric microbial pathogen. However, the major route of transmission remains poorly understood. The outcome of chronic H pylori infection varies from asymptomatic gastritis to peptic ulceration and gastric malignancies. Recently, H pylori has been associated with the development of extradigestive disorders, including refractory iron-deficiency (sideropenic) anemia and chronic autoimmune thrombocytopenic purpura. Virulence factors of H pylori and host genetic factors are both considered important determinants of disease outcome. Multiple tests, including novel noninvasive approaches, are available for establishing the presence of H pylori infection, but there is still little consensus about which study should be performed and in what clinical setting. Eradicating H pylori uses combination therapy, including a proton pump inhibitor and 2 antibiotics taken twice daily for 7 to 14 days. Antibiotic resistance is a growing and serious problem that interferes with the success of eradication therapy. Testing and eradication therapy for H pylori are currently recommended only for the subset of infected persons in whom the disease sequelae are proven or highly suspected.

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Guidelines for the investigation and management of idiopathic thrombocytopenic purpura in adults, children and in pregnancy

Cited by 696 publications

References 183 publications

Splenectomy for Chronic Idiopathic Thrombocytopenic Purpura in Children: A Single Center Study in China

Splenectomy for Chronic Idiopathic Thrombocytopenic Purpura in Children: A Single Center Study in China

Management of Acute Childhood Idiopathic Thrombocytopenic Purpura according to AIEOP Consensus Guidelines: Assessment of Italian Experience

What Is New Related to Helicobacter pylori Infection in Children and Teenagers?

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