IMMUNE THROMBOCYTOPENIC PURPURA IN CHILDHOOD IN NORWAY: A Prospective, Population-Based Registration

Zeller, Bernward; Helgestad, Jon; Hellebostad, Marit; Kolmannskog, S; Nystad, Tove A.; Stensvold, K.; Wesenberg, Finn

doi:10.1080/08880010050122816

Cited by 61 publications

(66 citation statements)

References 9 publications

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“…An updated version of this survey [9] showed similar rates of treatment versus observation; however, anti-D use was increased to 45% of children. Similarly a prospective population-based registration of Norwegian children with ITP (92 cases) revealed that 68% of children with acute childhood ITP are treated [26]. The preference for drug treatment in these surveys is similar to the ITP practice guidelines developed by the American Society of Hematology [4].…”

Section: Discussionmentioning

confidence: 58%

Treatment, outcome, and cost of care in children with idiopathic thrombocytopenic purpura

et al. 2005

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Data were reviewed on treatment patterns, outcome, and hospital charges for children with idiopathic thrombocytopenic purpura (ITP). Records of 186 children with ITP, seen between January 1997 and April 2001, were reviewed. Hospital charges for initial management and first re-treatment were calculated by combining physician, hospital, and pathology charges. Anti-D immune globulin [anti-D IG] was used in 32.3%, intravenous immune globulin [IVIG] in 22.6%, steroids in 22.6%, combination therapies in 8%, and 14.5% were observed. Two patients had CNS bleeding, one with intraventricular hemorrhage at diagnosis, and the other with a parietal bleed 1 year from diagnosis. There was no significant differences in time to reach platelet counts of 20, 50, or 150 (·10 9 /L) across different treatment groups. There was no significant difference in median charges for the IVIG and anti-D IG groups for the initial treatment of ITP. However, the IVIG was significantly more expensive than steroids or observation. Charges for the anti-D IG group were higher than the observation group but not the steroid group. After drug charges were excluded, patients in the IVIG group had statistically higher charges compared to patients in anti-D IG group. Almost half the patients were re-treated. There was no significant difference between anti-D IG, IVIG, and steroid groups when initial and re-treatment charges were combined. The observation group remained least expensive. Outcome for children with ITP is similar regardless of initial management. There is not a statistically significant difference in hospital charges between patients treated with anti-D IG and IVIG. The IVIG-treated group tends to be more costly, but this is not due to drug charges. Re-treatment is common and decreases the difference in patient charges among initial therapies. Am.

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Section: Discussionmentioning

confidence: 58%

Treatment, outcome, and cost of care in children with idiopathic thrombocytopenic purpura

et al. 2005

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“…Only 3% of children with ITP have clinically significant symptoms such as severe epistaxis or GI bleeding [173][174][175][176][177] (evidence level IIb/III). Severe bleeding is more likely in children with platelet counts less than 10 ϫ 10 9 /L 178 (evidence level III).…”

Section: Management Of Itp In Childhood: General Measuresmentioning

confidence: 99%

International consensus report on the investigation and management of primary immune thrombocytopenia

Provan¹,

Stasi

Newland³

et al. 2010

Blood

1,850

1,954

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IntroductionPrimary immune thrombocytopenia (ITP) is an acquired immunemediated disorder characterized by isolated thrombocytopenia, defined as a peripheral blood platelet count less than 100 ϫ 10 9 /L, and the absence of any obvious initiating and/or underlying cause of the thrombocytopenia. 1 Until recently, the abbreviation ITP stood for idiopathic thrombocytopenic purpura, but current awareness relating to the immune-mediated nature of the disease, and the absence or minimal signs of bleeding in a large proportion of cases have led to a revision of the terminology. 1 Concepts surrounding the mechanisms of thrombocytopenia in ITP have shifted from the traditional view of increased platelet destruction mediated by autoantibodies to more complex mechanisms in which both impaired platelet production and T cell-mediated effects play a role. [2][3][4][5][6] Recent epidemiologic data suggest that the incidence in adults is approximately equal for the sexes except in the mid-adult years (30-60 years), when the disease is more prevalent in women. 7,8 ITP is classified by duration into newly diagnosed, persistent (3-12 months' duration) and chronic (Ն 12 months' duration). 1 Whereas ITP in adults typically has an insidious onset with no preceding viral or other illness and it normally follows a chronic course, 9 ITP in children is usually short-lived with at least two-thirds recovering spontaneously within 6 months. 10 Signs and symptoms vary widely. Many patients have either no symptoms or minimal bruising, whereas others experience serious bleeding, which may include gastrointestinal hemorrhage (GI), extensive skin and mucosal hemorrhage, or intracranial hemorrhage (ICH). The severity of thrombocytopenia correlates to some extent but not completely with the bleeding risk. 7,11 Additional factors (eg, age, lifestyle factors, uremia) affect the risk and should be evaluated before the appropriate management is determined.The investigation and management of ITP patients vary widely. The purpose of this consensus document is to comment on new data and provide recommendations relating to diagnosis and treatment. Final judgment regarding care of individual patients should, however, lie with the responsible health care professional and be based on careful investigation of individual circumstances. MethodsComposition of the panel. The panel included 22 members with recognized clinical and research expertise in ITP representing North America (United States, 7; Canada, 1), Europe (France, 1; Italy, 2; Spain, 1; Switzerland, 1; United Kingdom, 8), and Australia (1).Assessment of the literature. Articles were identified by a computer-assisted search of the literature published in English using the National Library of Medicine PubMed database. The For personal use only. on May 7, 2018. by guest www.bloodjournal.org From search criteria were: 'immune thrombocytopenic purpura', 'idiopathic thrombocytopenic purpura', 'ITP', and 'autoimmune thrombocytopenic purpura'. A subsequent search was performed using the corresponding MedLin...

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“…A prospective, population-based registration of children with ITP conducted in Norway in 1996 and 1997 found an incidence of 5.3 per 100,000 children under 15 years old. The female:male ratio was 1.2:1 [3]. A population-based registry from 1998 to 2000 in five Nordic countries found a childhood incidence of 4.8 per 100 000 per year, with 25% of the children subsequently having chronic ITP [4].…”

Section: Introductionmentioning

confidence: 99%

Prevalence of immune thrombocytopenia: analyses of administrative data

Segal

Powe

2006

Journal of Thrombosis and Haemostasis

237

166

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Summary. Background: The prevalence of immune thrombocytopenic purpura (ITP) in the USA is unknown. The paucity of data makes clinical trial design and resource allocation challenging. Objectives: We aimed to quantify the prevalence of ITP in one state and to report on utilization of resources. Methods: The Maryland Health Care Commission supplied utilization data on all privately insured Maryland residents in 2002. We identified patients having two claims, separated by at least 30 days, for International Classification of Diseases, Ninth Revision, Clinical Modification code 287.3 (expected to be predominantly ITP). We excluded patients with concurrent diagnoses that made ITP unlikely. In sensitivity analyses, we varied the required visit interval between 14 and 180 days. We quantified ITP prevalence, resource utilization, and prevalence of concurrent autoimmune illnesses. Results: The age‐adjusted prevalence of ITP was 9.5 per 100 000 persons (10.5 per 100 000 when requiring a minimum 14‐day interval and 4.5 per 100 000 with a 180‐day interval). There was a predominance of males in childhood and of females in the middle‐adult years, with an overall prevalence rate ratio of 1.9 for females to males. Twenty per cent of these patients were hospitalized, but emergency department use was rare, as was splenectomy. A concurrent diagnosis of multiple sclerosis was 25 times more prevalent than anticipated. Conclusions: We conclude that the prevalence of ITP in one populous state in the USA is comparable with that which has been reported in Europe. The suggested co‐occurrence of ITP and multiple sclerosis in children merits further investigation.

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IMMUNE THROMBOCYTOPENIC PURPURA IN CHILDHOOD IN NORWAY: A Prospective, Population-Based Registration

Cited by 61 publications

References 9 publications

Treatment, outcome, and cost of care in children with idiopathic thrombocytopenic purpura

Treatment, outcome, and cost of care in children with idiopathic thrombocytopenic purpura

International consensus report on the investigation and management of primary immune thrombocytopenia

Prevalence of immune thrombocytopenia: analyses of administrative data

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