Platelets in Kawasaki disease: Is this only a numbers game or something beyond?

Arora, Kanika; Guleria, Sandesh; Jindal, Ankur Kumar; Rawat, Amit; Singh, Surjit

doi:10.1016/j.gendis.2019.09.003

Cited by 32 publications

(33 citation statements)

References 50 publications

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“…Thrombocytopenia in association with KD has been reported in literature [ 11 – 14 ] ( Table 2 ). The pathogenesis is unclear; however, previous studies have proposed a consumptive coagulopathy [ 11 , 15 ]. ITP as diagnosed by presence of immature megakaryocytes bone marrow has also been reported in the literature [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Autoimmune Hemolytic Anemia and Immune Thrombocytopenia: A Unique Presentation of Kawasaki Disease

Kupelian

Sathi

Singh

2021

Case Reports in Rheumatology

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Kawasaki disease is an acute multisystem vasculitis characterized by involvement of medium-sized vessels that mostly affects children under the age of 5 years. The presentation is typically preceded by five or more days of fever with additional clinical findings including rash, peripheral edema, mucositis, conjunctival changes, and unilateral cervical lymphadenopathy. The most feared complication of Kawasaki disease is development of coronary artery aneurysms. Common laboratory abnormalities include normocytic anemia, thrombocytosis, leukocytosis, and elevated inflammatory markers. Immune-mediated cytopenias such as autoimmune hemolytic anemia and thrombocytopenia are rarely seen at presentation in Kawasaki disease. We describe a unique case of a child presenting with autoimmune hemolytic anemia, who sequentially developed immune thrombocytopenia concerning for Evans’ syndrome and eventually diagnosed with Kawasaki Disease with coronary artery dilatation. Characteristic clinical findings including extremity edema, cracked lips, and rash developed later in the course. Our patient was treated with IVIG and steroids with significant clinical improvement and complete resolution of cytopenias and coronary aneurysms on long term follow up. Timely administration of IVIG prevents and minimizes the risk of long term cardiac consequences. Hence a high index of suspicion should be maintained for this relatively common pediatric illness, even in absence of more commonly seen laboratory findings.

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Section: Discussionmentioning

confidence: 99%

Autoimmune Hemolytic Anemia and Immune Thrombocytopenia: A Unique Presentation of Kawasaki Disease

Kupelian

Sathi

Singh

2021

Case Reports in Rheumatology

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“…Thrombocytosis is characteristic during the subacute phase, peaking in the third week and normalizing 4-to-6 weeks after onset. Thrombocytopenia is rare, but may occur in the first 1–2 weeks of illness: it can be a sign of disseminated intravascular coagulation or macrophage activation syndrome (MAS) and is a risk factor for the development of CAA [ 23 ].…”

Section: Investigations In Kawasaki Diseasementioning

confidence: 99%

Revised recommendations of the Italian Society of Pediatrics about the general management of Kawasaki disease

et al. 2021

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Aim of these revised recommendations for the general management of Kawasaki disease is to encourage its prompter recognition and warrant the most appropriate therapy, based on ascertained scientific data, raising awareness of the complications related to misdiagnosis or delayed treatment. A set of 20 synthetic operative statements is herein provided, including the definition of Kawasaki disease, its protean presentations, clinical course and seminal treatment modalities of all disease phases. The application of these recommendations should improve prognosis of Kawasaki disease and prevent the progression to permanent vascular abnormalities, thereby diminishing morbidity and mortality.

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“…Thus, experts recommend that treatment should only be given to KD patients who have other risk factors for thrombosis. 19 Normochromic and normocytic anemia is commonly discovered during KD laboratory workup, but it resolves along with the subsidence of KD's inflammation process. Forty to sixty percent of KD patients have Case Report mild to moderate elevations of serum transaminases or gamma-glutamyl transpeptidase, and only 10 % of KD patients have mild hyperbilirubinemia.…”

Section: Case Reportmentioning

confidence: 99%

“…for at least 6-8 weeks, 9,11,19 or dependent on findings on echocardiography. 4 In the UK practices, Case Report pediatricians prescribe aspirin dose as 30 mg/kg/day during the acute phase of the illness for more tolerance of the gastrointestinal and other side effects.…”

Section: Case Reportmentioning

confidence: 99%

“…2,20 Experts recommend that IVIG 2 g/kg be administered together with acetylsalicylic acid as a single infusion over 10 to 12 hours. 1,11,19 Less severe adverse reactions related to the IVIG regiment, including fever, chills, and hypotension, are variously linked with the specific product infused. Due to the immunogenicity reduction of the passive antibodies in IVIG preparation which are "vaccine-related", clinicians should defer injections of live virus vaccines (mumps, measles, varicella and rubella) at least 11 months after IVIG administration.…”

Section: Journal Of Medicine and Healthmentioning

confidence: 99%

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Atypical Kawasaki Disease in a Two-Year-Old Girl with Initial Presentation of Acute Diarrhea

Situmorang

Karina

2021

JMH

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Kawasaki Disease is a spectrum of idiopathic, self-limited fever disease affecting childrenunder 5 years old. This disorder can be challenging to be diagnosed by a pediatrician since thereis no specific diagnostic laboratory test. One atypical Kawasaki Disease case presented withgastrointestinal symptoms, a two-year-old girl was hospitalized with fever, accompanied by non-hemorrhagic diarrhea three days before admission. Physical examination revealed unilateralcervical lymph enlargement and mild-moderate dehydration. Initial laboratory examinationresult showed thrombocytosis, leukocytosis (shift to the left), and normal routine fecal analysis.The patient was initially diagnosed with acute diarrhea with mild-moderate dehydration. She wastreated with a rehydration regimen and antibiotic, but her fever persisted. On the third day ofhospitalization, she fulfilled 3 of the classic Kawasaki Disease criteria (conjunctivitis, crackedlips with strawberry tongue, and lymphadenopathy). Further blood work resulted in increased C-reactive protein 43.35 mg/L and ESR 72 mm/hour, while chest X-ray and electrocardiographwere within normal limit. This patient was proceed to Hasan Sadikin General Hospital for furtherexamination and therapy. Atypical Kawasaki Disease can be a puzzling diagnosis due to itsuncommon presentations. Clinicians should importantly keep it in mind as a differential diagnosisin patients with prolonged fever. Keywords: atypical Kawasaki disease; diarrhea; prolonged fever

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Platelets in Kawasaki disease: Is this only a numbers game or something beyond?

Cited by 32 publications

References 50 publications

Autoimmune Hemolytic Anemia and Immune Thrombocytopenia: A Unique Presentation of Kawasaki Disease

Autoimmune Hemolytic Anemia and Immune Thrombocytopenia: A Unique Presentation of Kawasaki Disease

Revised recommendations of the Italian Society of Pediatrics about the general management of Kawasaki disease

Atypical Kawasaki Disease in a Two-Year-Old Girl with Initial Presentation of Acute Diarrhea

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