Intracranial hemorrhage in childhood immune thrombocytopenic purpura

Choudhary, Deepak; Naithani, Rahul; Mahapatra, Manoranjan; Kumar, Rajat; Mishra, Pravas; Saxena, Renu

doi:10.1002/pbc.21728

Cited by 24 publications

(34 citation statements)

References 13 publications

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“…Similar results were reported by Japanese studies (0.45 and 0.52%) [12,13]. Other Eastern populations such as Turkey and India reported an even higher incidence of 1.2–3.3% [9,14,15], but the latter was attributed to referral bias. However, other studies reported a much lower incidence of 0.17 [3] and 0.24% [5].…”

Section: Discussionsupporting

confidence: 83%

“…Predisposing factors, predictors and outcome of ICH in ITP have been difficult to ascertain due to the rare occurrence of this complication. ICH is a significant cause of morbidity and mortality [4] though its incidence varies from about 0.1 to 1.0% [5,6,7] up to 2% in some studies [8,9]. This study was carried out to better understand ICH in Egyptian children with ITP, including its incidence, risk factors, management and outcome.…”

Section: Introductionmentioning

confidence: 99%

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Intracranial Hemorrhage in Acute and Chronic Childhood Immune Thrombocytopenic Purpura over a Ten-Year Period: An Egyptian Multicenter Study

Elalfy

Elbarbary

Khaddah³

et al. 2009

Acta Haematol

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Intracranial hemorrhage (ICH) is a rare but major cause of death in immune thrombocytopenic purpura (ITP). The authors reviewed data of 1,840 patient with ITP, from 5 pediatric hematology centers in Egypt from 1997 to 2007, to study the incidence and risk factors of ICH. Ten cases of ICH were identified with a median age at presentation of 7.5 years; 4 patients had acute ITP, 2 persistent and 4 chronic. The platelet count was <10 × 10⁹/l in 7 cases, and only 1 patient had a history of head trauma. Seven children were on treatment prior to or at the time of occurrence of ICH and all were treated by pharmacotherapy. Two children died shortly afterwards due to late referral to a specialized center. Our results suggest that treatment does not prevent ICH and that it can occur at any time during the course of the disease. Delayed referral can be considered a risk factor for unfavorable outcome of ICH, highlighting the importance of teaching sessions for patients and their parents to minimize subsequent morbidity and mortality of ICH in children with ITP.

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Section: Discussionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Intracranial Hemorrhage in Acute and Chronic Childhood Immune Thrombocytopenic Purpura over a Ten-Year Period: An Egyptian Multicenter Study

Elalfy

Elbarbary

Khaddah³

et al. 2009

Acta Haematol

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“…The most significant clue in these patients is the presence of mucocutenous (wet¬-purpura) bleeding (49%). 77% of bleedings are intracranial hemorrhages (87% supratentorial) and 23% are subdural hemorrhages (1,21,22).…”

Section: History and Clinical Findingsmentioning

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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“…It is thought that children younger than 3 years of age and those with mucosal bleeding face a higher risk of ICH (13). Trauma and the use of nonsteroidal anti-inflammatory drugs have also been reported as precipitating factors for ICH (13,14).…”

Section: Introductionmentioning

confidence: 99%

Using a standardised protocol was effective in reducing hospitalisation and treatment use in children with newly diagnosed immune thrombocytopenia

et al. 2017

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Aim: Childhood immune thrombocytopenia (ITP) has been associated with low bleeding rates and a high frequency of spontaneous remission. Although current guidelines suggest that most patients are just observed, children still receive platelet-enhancing therapies for fear of bleeding complications. We hypothesised that a standardised protocol with a stepdown approach would reduce hospitalisation and treatment use.Method: A retrospective chart review was performed on patients diagnosed with acute ITP between January 2010 and December 2014, before (n = 54) and after (n = 37) the standardised protocol, which was introduced in January 2013. Management and events during the first 3 months following diagnosis were recorded. Results:The protocol resulted in a 34% decrease in the hospitalisation rate (p < 0.001) at diagnosis. Prednisone treatment duration at diagnosis was also significantly reduced (13.1 versus 5.8 days, p = 0.004). Children over 3 years of age were 3.8 times less likely to be hospitalised (95% CI 1.94-7.61) and 2.3 times less likely to receive treatment (95% CI 1.2-4.3). There was no difference in the rate of persistent ITP (38% versus 30%, p = 0.43) or serious bleeding complications (7% versus 5%, p = 0.70).

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Intracranial hemorrhage in childhood immune thrombocytopenic purpura

Cited by 24 publications

References 13 publications

Intracranial Hemorrhage in Acute and Chronic Childhood Immune Thrombocytopenic Purpura over a Ten-Year Period: An Egyptian Multicenter Study

Intracranial Hemorrhage in Acute and Chronic Childhood Immune Thrombocytopenic Purpura over a Ten-Year Period: An Egyptian Multicenter Study

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

Using a standardised protocol was effective in reducing hospitalisation and treatment use in children with newly diagnosed immune thrombocytopenia

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