Predictors of chronic idiopathic thrombocytopenic purpura

Elalfy, Mohsen Saleh; Farid, Samar M.; Maksoud, Abeer Abdel

doi:10.1002/pbc.22481

Cited by 33 publications

(45 citation statements)

References 25 publications

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“…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.…”

Section: Laboratory Measurementsmentioning

confidence: 99%

“…[19][20][21][22]29,[32][33][34]36,39,41,43,44 Preceding infections and vaccinations. Seven studies analyzed whether an infection before the onset of ITP was correlated with development of chronic ITP 19,22,23,29,30,32,37 ; 4 studies evaluated the occurrence of viral infections only. 21,33,34,36 A preceding vaccination was evaluated in 3 studies, 18,22,30 and 2 articles reported the incidence of a preceding infection or vaccination as one combined predictor.…”

Section: Clinical Predictorsmentioning

confidence: 99%

“…Eighteen articles analyzed the mean age at time of diagnosis of ITP between children that recovered and those that developed chronic ITP. 11,12,16,19,20,[22][23][24][25][26][27]29,30,32,37,[40][41][42] Two articles did not publish standard deviations or 95% CIs. 30,40 Patients who developed chronic ITP were older, and the mean difference was 2.68 (95% CI 1.89-3.47) years.…”

Section: Clinical Predictorsmentioning

confidence: 99%

“…Five articles studied the onset of disease and found significant more chronic ITP in patients with an insidious onset of ITP, with an OR of 11.27 (95% CI 6.27-20.27; Figure 3). 18,29,33,34,36 Bleeding symptoms. Two studies analyzed the correlation between the absence of bleeding symptoms at diagnosis and a chronic course of ITP, and both did not find this to be a risk factor.…”

mentioning

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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Section: Laboratory Measurementsmentioning

confidence: 99%

Section: Clinical Predictorsmentioning

confidence: 99%

Section: Clinical Predictorsmentioning

confidence: 99%

mentioning

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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“…The severity of thrombocytopenia associated to some extent but not completely with the propensity to bleed which necessitates more factors to be evaluated [28,29]. On the other hand, increased platelet antibodies level is only one of several factors involved in development of the clinical status of ITP.…”

Section: Discussionmentioning

confidence: 99%

Clinical Significance of Positive Platelet Immunofluorescence Assay in Adult Immune Thrombocytopenia

Rostami

Borhani

Khaledi

2014

Indian J Hematol Blood Transfus

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Immune thrombocytopenia (ITP) is a relatively common hematologic disorder manifested by low platelet count due to immune-mediated platelet destruction and/or suppression of platelet production. This study aim was to evaluate characteristics and clinical presentation of adult patients with ITP and exploring the clinical value of platelet antibodies assay in proposed cases in Iranian population. In this prospective case series 46 adult patients with ITP and platelet count of \100 9 10 9 /L, referred to the Taleghani Medical Center, Tehran, Iran between 2007 and 2009 were evaluated. There were 26 females and 20 males (1.3:1) with mean age of 38.9 ± 19.7 years. The platelet autoantibodies were measured by means of indirect platelet suspension immunofluorescence test. According to our results, 7 patients (15.2 %) displayed a positive platelet antibody assay. There was a significant negative correlation between platelet count and antibody level (r = -0 0.59; p \ 0.001). Additionally, a positive correlation between platelet count and patients' age (r = 0.302; p = 0.042) was detected. 20 patients (56.5 %) were symptomatic at presentation and the most common bleeding signs were petechia, purpura and epistaxis. Results indicated no significant correlation between increased platelet antibody level and bleeding manifestations except for hematuria (r = 0.435; p = 0.02) and epistaxis (r = 0.382; p = 0.015). Disclosure of platelet autoantibodies and the consequential thrombocytopenia associated to some extent but not completely with the propensity to bleed which necessitates more factors to be evaluated.

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Predictive factors for resolution of childhood immune thrombocytopenia: Experience from a single tertiary center in Thailand

Chotsampancharoen

Sripornsawan

Duangchoo

et al. 2016

Pediatric Blood & Cancer

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Predictors of chronic idiopathic thrombocytopenic purpura

Abstract: The most relevant risk factors for the development of chronic ITP included a gradual mode of onset of symptoms over more than 2 weeks period, initial platelet count >20 x 10(9)/L, and age more than 10 years at presentation.

Cited by 33 publications

References 25 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

Clinical Significance of Positive Platelet Immunofluorescence Assay in Adult Immune Thrombocytopenia

Predictive factors for resolution of childhood immune thrombocytopenia: Experience from a single tertiary center in Thailand

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