The Clinical Outcome of 260 Pediatric ITP Patients in One Center

Akbayram, Sinan; Doğan, Murat; Üstyol, Lokman; Akgün, Cihangir; Peker, Erdal; Bilici, Salim; Çaksen, Hüseyîn; Öner, Ahmet Faik

doi:10.1177/1076029610379849

Cited by 17 publications

(25 citation statements)

References 36 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).…”

Section: 2334mentioning

confidence: 76%

“…18,22,30,31 Three studies found significant less chronic ITP in patients with mucosal bleeding (OR 0.39; 95% CI 0.28-0.54).…”

Section: Clinical Predictorsmentioning

confidence: 99%

“…18,19,27,33 Thirteen articles studied age .11 years, with a statistically significant overall OR of 2.47 (95% CI 1.94-3.15; Figure 2). [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.…”

Section: Clinical Predictorsmentioning

confidence: 99%

“…on May 7, 2018. by guest www.bloodjournal.org From differences were found. 22,27,30,49 Observational management vs any medical treatment was studied in 10 articles, but no significant differences were found ( Figure 5). 19,22,27,[30][31][32]37,44,46,48 In 5 studies, combination therapy with SDMP and IVIg was analyzed.…”

mentioning

confidence: 99%

“…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.18,31 Figure 3 shows that the absence of an infection or vaccination in the medical history shortly before the first clinical signs of ITP is significantly correlated with a chronic course of the disease (pooled OR 3.08, 95% CI 2.19-4.32).Onset of disease. 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).…”

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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