Severe hemorrhage in children with newly diagnosed immune thrombocytopenic purpura

Neunert, Cindy; Buchanan, George R.; Imbach, Paul; Bolton‐Maggs, Paula; Bennett, Carolyn M.; Neufeld, Ellis J.; Vesely, Sara K.; Adix, Leah; Blanchette, Victor S.; Kühne, Thomas

doi:10.1182/blood-2008-03-138487

Cited by 180 publications

(147 citation statements)

References 36 publications

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“…Results are descriptive, including 95% exact confidence intervals. A one-sample proportion test compare the frequency of occult hemorrhage by site (urine, stool, CNS) with the incidence of overt hemorrhage in children with ITP reported in the literature [17][18][19][20] (Table I). The incidence of blood in the urine and stool reported in the literature for healthy children [21][22][23] was used as a comparison group.…”

Section: Introductionmentioning

confidence: 99%

Occult hemorrhage in children with severe ITP

Flores

Buchanan

2016

American J Hematol

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Little is known about the frequency and significance of clinically unapparent or occult hemorrhage in ITP. Therefore, we prospectively explored the sites and frequency of occult bleeding in children with severe ITP at diagnosis or upon symptomatic relapse in a prospective, single-institution cohort study of patients 18 years of age and a platelet count 10,000/mm 3 . Data collected included bleeding severity assessment, urinalysis, fecal occult blood testing, and non-contrast brain MRI. Stool and urine samples were tested within 7 days of diagnosis or symptomatic relapse. Three months after diagnosis or relapse a noncontrast brain MRI evaluated hemosiderin deposits resulting from prior localized hemorrhage. Fifty-two ITP patients were enrolled with a mean platelet count of 4,000/mm 3 . A significant occurrence of occult hemorrhage was identified in the urine (27%) compared with clinically overt hematuria (0.91%, P < 0.0005). CNS microbleeding in the superficial cortex of the left frontal lobe was identified in one child with occult bleeding in the urinary tract. There was no relationship between occult hemorrhage and bleeding manifestations on physical examination. Occult hemorrhage was not a harbinger of subsequent bleeding. Our findings suggest that occult hemorrhage occurs with greater frequency than overt bleeding in children with severe ITP. CNS microbleeding is a potential risk in this patient population. Assessment of brain microbleeds and microscopic hematuria in this patient population require additional study.

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Section: Introductionmentioning

confidence: 99%

Occult hemorrhage in children with severe ITP

Flores

Buchanan

2016

American J Hematol

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“…11 Patient registration is based on voluntary participation by physicians involved in the management of patients with ITP worldwide. Information about the Registry was made available on the internet (www.itpbasel.ch), at scientific conferences and symposia, meetings organized by ICIS, and publication of regular newsletters and journal supplements.…”

Section: Registry Designmentioning

confidence: 99%

Newly diagnosed immune thrombocytopenia in children and adults: a comparative prospective observational registry of the Intercontinental Cooperative Immune Thrombocytopenia Study Group

Kühne

Berchtold²,

Michaels³

et al. 2011

Haematologica

135

109

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BackgroundPrimary immune thrombocytopenia is a bleeding diathesis with an unknown etiology in predisposed individuals with immune disturbances. Although it is claimed that children and adults differ in clinical and laboratory aspects, few data exist to corroborate this observation. Our objective was to assess comparative data from children and adults with newly diagnosed immune thrombocytopenia. Design and MethodsClinical and laboratory data of 1,784 children and 340 adults were extracted from the Pediatric and Adult Registry on Chronic Immune Thrombocytopenia. The registry represents a prospective cohort of children and adults with newly diagnosed immune thrombocytopenia. Participating investigators registered their patients immediately after the diagnosis using a web based data transfer. Children aged under 16 years were compared with adults aged 16 years and over with descriptive statistical analyses. ResultsThe presenting mean platelet count of children and adults was 18.1 and 25.4¥10 9 /L. Signs of bleeding were reported in 24% of children and in 23% of adults, and intracranial hemorrhage in 10 of 1,784 children and in 6 of 340 adults. Co-morbidity was observed in 3.9% of children and in 30% of adults. Bone marrow aspiration and laboratory tests (antinuclear antibodies, human immunodeficiency and hepatitis C virus) were performed more frequently in adults. Children and adults were followed with a 'watch and wait' strategy in 20% and in 29%, respectively. Immunoglobulins were used more frequently in children and corticosteroids in adults. ConclusionsComparative data of children and adults with newly diagnosed immune thrombocytopenia revealed similarities in presenting platelet counts and in bleeding, whereas differences occurred in co-morbidity, diagnostic procedures and therapy.Key words: immune thrombocytopenia, newly diagnosed, similarities, differences, comparative data. Group. Haematologica 2011;96(12):1831-1837. doi:10.3324/haematol.2011 This is an open-access paper. Citation Newly diagnosed immune thrombocytopenia in children and adults: a comparative prospective observational registry of the Intercontinental Cooperative Immune Thrombocytopenia Study Group

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“…Therefore, ITP is usually recognised as a benign condition, with at least 75% of children having minor or no bleeding in spite of extremely low platelet counts (10,11). Nevertheless, severe haemorrhages, such as intractable epistaxis, gastrointestinal bleed or intracranial haemorrhages (ICH), may occur (12). It is thought that children younger than 3 years of age and those with mucosal bleeding face a higher risk of ICH (13).…”

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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Severe hemorrhage in children with newly diagnosed immune thrombocytopenic purpura

Abstract: Controversy exists regarding management of children newly diagnosed with immune thrombocytopenic purpura (ITP

Cited by 180 publications

References 36 publications

Occult hemorrhage in children with severe ITP

Occult hemorrhage in children with severe ITP

Newly diagnosed immune thrombocytopenia in children and adults: a comparative prospective observational registry of the Intercontinental Cooperative Immune Thrombocytopenia Study Group

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

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