Possible lower rate of chronic ITP after IVIG for acute childhood ITP an analysis from registry I of the Intercontinental Cooperative ITP Study Group (ICIS)

Tamminga, Rienk; Berchtold, Willi; Bruin, Marrie C.A.; Buchanan, George R.; Kühne, Thomas

doi:10.1111/j.1365-2141.2009.07743.x

Cited by 49 publications

(56 citation statements)

References 24 publications

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“…Figure 5). 19,22,26,27,[30][31][32]37,44,46,[48][49][50] No significant differences were found. Fourteen studies analyzed the influence of treatment with IVIg and found significantly less chronic ITP in patients treated with IVIg (OR 0.71, 95% CI 0.52-0.97) ( Figure 5).…”

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confidence: 74%

“…The mean platelet count at time of diagnosis was calculated in 12 studies. 19,20,23,24,26,27,29,30,37,[41][42][43] A significantly higher platelet count at diagnosis was found in patients who developed chronic ITP, with a mean difference 5.27 (95% CI 2.69-7.86). Four articles calculated a median platelet count, and 1 found significantly higher median platelet counts at diagnosis in patients who developed chronic ITP.…”

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confidence: 99%

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Clinical and laboratory predictors of chronic immune thrombocytopenia in children: a systematic review and meta-analysis

Heitink‐Pollé

Nijsten

Boonacker

et al. 2014

Blood

131

124

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Key Points• Older age, insidious onset, no preceding infection, mild bleeding, and higher platelet count are the strongest risk factors for chronic ITP.• Intravenous immunoglobulin treatment seems to protect against development of chronic ITP.Childhood immune thrombocytopenia (ITP) is a rare autoimmune bleeding disorder. Most children recover within 6 to 12 months, but individual course is difficult to predict. We performed a systematic review and meta-analysis to identify predictors of chronic ITP. We found 1399 articles; after critical appraisal, 54 studies were included. The following predictors of chronic ITP in children, assessed in at least 3 studies, have been identified: female gender (odds ratio [OR] 1.17, 95% confidence interval [CI] 1.04-1.31), older age at presentation (age ‡11 years; OR 2.47, 95% CI 1.94-3.15), no preceding infection or vaccination (OR 3.08,, insidious onset (OR 11.27,), higher platelet counts at presentation ( ‡20 3 10 9 /L: OR 2.15, 95% CI 1.63-2.83), presence of antinuclear antibodies (OR 2.87, 95% 1.57-5.24), and treatment with a combination of methylprednisolone and intravenous immunoglobulin (OR 2.67, 95% CI 1. 44-4.96). Children with mucosal bleeding at diagnosis or treatment with intravenous immunoglobulin alone developed chronic ITP less often (OR 0.39, 95% CI 0.28-0.54 and OR 0.71, 95% CI 0.52-0.97, respectively). The protective effect of intravenous immunoglobulin is remarkable and needs confirmation in prospective randomized trials as well as future laboratory studies to elucidate the mechanism of this effect. (Blood. 2014;124(22):3295-3307) IntroductionChildhood immune thrombocytopenia (ITP) is a rare autoimmune disorder characterized by isolated thrombocytopenia (peripheral blood platelet count ,100 3 10 9 /L) in the absence of other causes that may be associated with thrombocytopenia.1 Most children present with a typical history of acute development of purpura and bruising, often after a mild viral infection. Management of newly diagnosed ITP consists of careful observation, regardless of platelet count. Severe bleeding, occurring in only 3% to 5% of children, 2 requires treatment with corticosteroids, intravenous immunoglobulin (IVIg), or anti-Rhesus-D immunoglobulin, either alone or in combination and, if life threatening, also with platelet and red blood cell transfusions. 3,4 Chronic ITP is currently defined as thrombocytopenia ,100 3 10 9 /L lasting for .12 months.1 About 20% to 25% of children with newly diagnosed ITP will develop chronic disease. Because of the high impact of ITP on a child's everyday life and activities, as well as to decide whether treatment has to be instituted to influence the clinical course of ITP, it is of clinical significance if the course of the disease could be predicted at time of diagnosis.Several clinical, therapeutic, laboratory, and genetic predictors of chronic ITP have been evaluated in children.5-7 A systematic review or meta-analysis, however, has not yet been performed. In this study, we systematically analyzed all...

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confidence: 74%

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confidence: 99%

Clinical and laboratory predictors of chronic immune thrombocytopenia in children: a systematic review and meta-analysis

Heitink‐Pollé

Nijsten

Boonacker

et al. 2014

Blood

131

124

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“…Estimates of ITP incidence range between 2 and 5 cases per 100 000 per year in children who are younger than 15 years old [4][5][6]; prevalence estimates range between 4.1 and 12.6 cases per 100 000, depending on age, with a mean prevalence of approximately 7.2 cases per 100 000 in children younger than 18 years old [7][8]. Approximately 75% of pediatric ITP cases are newly diagnosed and persistent, with the remaining cases considered chronic [9][10][11][12]. ITP in children is often associated with an antecedent illness or infection and often resolves within 1-6 months [11,13].…”

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confidence: 99%

“…The most common initial therapies for pediatric ITP include intravenous immunoglobulin (IVIg), corticosteroids, or both [12,27]. Subsequent treatments include corticosteroids, corticosteroids with high-dose IVIg, IV Rho(D) Ig, immunosuppressive agents, and rituximab [3,28].…”

Section: Introductionmentioning

confidence: 99%

Hospitalizations in pediatric patients with immune thrombocytopenia in the United States

Tarantino

Danese²,

Klaassen

et al. 2016

Platelets

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To examine utilization and outcomes in pediatric immune thrombocytopenia (ITP) hospitalizations, we used ICD-9 code 287.31 to identify hospitalizations in patients with ITP in the 2009 HCUP KID, an all-payer sample of pediatric hospitalizations from US community hospitals. Diagnosis and procedure codes were used to estimate rates of ITP-related procedures, comorbidity prevalence, costs, length of stay (LOS), and mortality. In 2009, there were an estimated 4499 hospitalizations in children aged 6 months-17 years with ITP; 43% in children aged 1-5 years; and 47% with emergency department encounters. The mean hospitalization cost was $5398, mean LOS 2.0 days, with 0.3% mortality (n = 13). With any bleeding (15.2%, including gastrointestinal 2.0%, hematuria 1.3%, intracranial hemorrhage [ICH] 0.6%), mean hospitalization cost was $7215, LOS 2.5 days, with 1.5% mortality. For ICH (0.6%, n = 27), mean cost was $40 209, LOS 8.5 days, with 21% mortality. With infections (14%, including upper respiratory 5.2%, viral 4.9%, bacterial 1.9%), the mean cost was $6928, LOS 2.9 days, with 0.9% mortality. Septic shock was reported in 0.3% of discharges. Utilization included immunoglobulin administration (37%) and splenectomies (2.3%). Factors associated with higher costs included age >6 years, ICH, hematuria, transfusion, splenectomy, and bone marrow diagnostics (p < 0.05). In conclusion, of the 4499 hospitalizations with ITP, mortality rates of 1.5%, 21%, and 0.9% were seen with any bleeding, ICH, and infection, respectively. Higher costs were associated with clinically significant bleeding and procedures. Future analyses may reveal effects of the implementation of more recent ITP guidelines and use of additional treatments.

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“…There are two lines of evidence. Firstly, recent analysis of the Intercontinental Registry Data suggests that children initially treated with IVIG were more likely to have a normal platelet count at 6 months from diagnosis than those not receiving it [5]. Secondly, the use of pulses of high-dose dexamethasone in two pilot studies in adults [6] (40 mg daily for 4 days every 14 or 28 days for four to six cycles) suggest a higher rate and a longer duration of remission, and this is now being tested in a prospective randomised study.…”

Section: Introductionmentioning

confidence: 99%

Chronic immune thrombocytopenic purpura—who needs medication?

Kok

2010

Ann Hematol

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Chronic ITP (immune thrombocytopenic purpura; now defined as duration of more than 12 months) is not always associated with significant bleeding problems so that most children and adults can be managed expectantly with no medication unless surgery, accidents or other pathology mandate it. A cut-off platelet count of 30×10 9 /l divides a group with no increased mortality from those whose risk is greater and in whom medication is usually appropriate. There is increasing recognition of long-term morbidity and mortality associated with immune suppression induced by medication and more recently new concerns have arisen about the long-term vascular complications of splenectomy. A more conservative approach to medication is warranted in many patients with chronic ITP.

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Possible lower rate of chronic ITP after IVIG for acute childhood ITP an analysis from registry I of the Intercontinental Cooperative ITP Study Group (ICIS)

Cited by 49 publications

References 24 publications

Clinical and laboratory predictors of chronic immune thrombocytopenia in children: a systematic review and meta-analysis

Clinical and laboratory predictors of chronic immune thrombocytopenia in children: a systematic review and meta-analysis

Hospitalizations in pediatric patients with immune thrombocytopenia in the United States

Chronic immune thrombocytopenic purpura—who needs medication?

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