Bleeding manifestations in severely thrombocytopenic children with immune thrombocytopenic purpura

Chandra, Jagdish; Ravi, Rakesh; Singh, Varinder; Narayan, Shashi; Sharma, Sunita; Dutta, A. K.

doi:10.1080/10245330600574367

Cited by 15 publications

(6 citation statements)

References 11 publications

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“…Nonetheless, all these treatments have significant side effects and do not increase the probability of recovery [69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96,97,98]. …”

Section: Treatmentsmentioning

confidence: 99%

Management of Chronic Childhood Immune Thrombocytopenic Purpura: AIEOP Consensus Guidelines

et al. 2009

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Background/Objective: The management of chronic childhood idiopathic thrombocytopenic purpura (ITP) is distinct from acute ITP. Similar to the publication on acute ITP guidelines, the AIEOP (Associazione Italiana di Ematologia e Oncologia Pediatrica) considered it appropriate to develop consensus guidelines for chronic childhood ITP to provide useful and shared information for physicians, healthcare professionals, parents and patients. Design/Methods: A preliminary, evidence-based document issued by a select group of AIEOP pediatric hematologists was discussed, modified and approved during a Consensus Conference according to procedures previously validated by the AIEOP Board. Results: The guidelines give prominence to the periodical reevaluation of all the etiological hypotheses of thrombocytopenia in relation to its clinical condition. The majority of chronic ITP children do not require treatment, especially if bleeding is absent or minimal. The treatment decision depends on several factors other than the platelet count, and treatment options are suggested in relation to the therapeutic scenarios. Recommendations are given regarding support for surgery, particular hemorrhagic conditions, daily activities/sports, as well as for vaccines and drugs. Experimental treatments are also discussed.

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Section: Treatmentsmentioning

confidence: 99%

Management of Chronic Childhood Immune Thrombocytopenic Purpura: AIEOP Consensus Guidelines

et al. 2009

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“…Considerando que 153 pacientes (81,8%) receberam algum gravidade do sangramento. Em outro estudo 23 observou-se que a frequência de manifestações hemorrágicas leves era maior nos episódios em que a contagem de plaquetas situava-se entre 10 e 20x10 9 /L, quando comparada com episódios com contagens inferiores a 10x10 9 /L. Todos os estudos, inclusive o aqui apresentado, trazem as limitações advindas da dificuldade em se definir a medida da hemorragia, seja cutânea ou mucosa (wet purpura, dry purpura), e da superposição que muitas vezes ocorre entre um grau e outro na classificação.…”

Section: Discussionunclassified

Púrpura trombocitopênica imune da criança: experiência de 12 anos em uma única instituição brasileira

Delgado¹,

Viana²,

Fernandes³

2009

Rev. Bras. Hematol. Hemoter.

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O objetivo deste trabalho foi determinar a frequência dos quadros clínicos da púrpura trombocitopênica imune e sua associação com contagem de plaquetas, taxa de resposta à esplenectomia e fatores preditivos do desfecho e da evolução para a cronicidade. Realizou-se estudo retrospectivo com 187 crianças diagnosticadas no Hospital das Clínicas da UFMG, entre 04/1988 e 12/2001. Quadros assintomáticos e leves corresponderam a 76% do total. Hemorragias exclusivamente cutâneas ocorreram em 96% dos casos sintomáticos. A gravidade dos sintomas associou-se à intensidade da plaquetopenia. Evolução aguda foi apresentada por 123 pacientes (70,7%) e crônica por 51 (29,3%). A apresentação insidiosa (26,2%) associou-se a um maior número de esplenectomias (p=4x10-7), a uma menor taxa de resposta à corticoterapia (p=0,003) e constituiu-se, juntamente com a ausência de resposta à corticoterapia (p<1x10-7), em fator preditivo da cronicidade (p=1x10-7). Taxa de resposta de 74,5% foi alcançada com a esplenectomia. Remissão foi o desfecho final em 80,2% dos pacientes. Foram preditivos de remissão final: gênero masculino (p=0,02), número baixo de plaquetas ao diagnóstico (p=0,004), resposta à corticoterapia (p=0,003) e ocorrência de uma primeira remissão (p<1x10-7). Confirmou-se que a doença na criança é benigna e autolimitada. Houve associação entre gravidade dos sintomas e intensidade da plaquetopenia. Constituíram-se fatores preditivos da cronicidade: apresentação insidiosa e ausência de resposta à corticoterapia. Constituíram-se fatores associados à remissão final: gênero masculino, número mais baixo de plaquetas ao diagnóstico, resposta à corticoterapia inicial e ocorrência de uma primeira remissão. Rev. Bras.

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“…The limited number of studies done in low-income countries have shown that children with severe thrombocytopenia, particularly when the platelet count is between 10 000 and 20 000/mm 3 [19,49], can safely be managed with "watchful waiting" without any specific therapeutic intervention. Chandra et al from India compared the bleeding manifestations when the platelet count was < 10 000/mm 3 and those between 10 000-20 000/mm 3 and showed that in 76.6% of episodes with counts > 10 000/ mm 3 there was no or only cutaneous bleeding compared to 59.5% episodes of bleeding when the platelet count was < 10 000 /mm 3 (P < 0.05) [49]. Kalim et al from Pakistan also advised a wait-and-see policy [19].…”

Section: Managementmentioning

confidence: 99%

Immune thrombocytopenia in children with reference to low income countries

Rehman¹

2009

East Mediterr Health J

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Immune thrombocytopenia is a benign and self-limiting disorder. Data about the condition and its incidence from low-income countries is limited. This paper reviews the research about immune thrombocytopenia, comparing low-and high-income countries. Diagnosis is usually based on complete blood count and peripheral smear and, in selected cases, bone marrow aspiration. The disease has a high remission rate both in high-and low-income countries and intracranial haemorrhage is rare. The recommended treatment is simply observation of cases, especially when the platelet count is > 10 000 /mm 3 . If drug therapy is required, oral steroids are the most economical choice. ‫ﺍﻟﺪﺧﻞ‬ ‫ﺍﳌﻨﺨﻔﻀﺔ‬ ‫ﺍﻟﺒﻠﺪﺍﻥ‬ ‫ﰲ‬ ‫ﺍﻷﻃﻔﺎﻝ‬ ‫ﻟﺪ‬ ‫ﺍﳌﻨﺎﻋﻲ‬ ‫ﺍﻟﺼﻔﻴﺤﺎﺕ‬ ‫ﻧﻘﺺ‬‫ﺍﻟﺮﲪﻦ‬ ‫ﻋﺒﺪ‬ ‫ﻫﺬﺍ‬ ‫ﺣﺎﻟﺔ‬ ‫ﺣﻮﻝ‬ ‫ﺷﺤﻴﺤﺔ‬ ‫ﻭﺍﳌﻌﻄﻴﺎﺕ‬ . ‫ﹰ‬ ‫ﺗﻠﻘﺎﺋﻴﺎ‬ ‫ﻳﺰﻭﻝ‬ ‫ﲪﻴﺪ‬ ‫ﺍﺿﻄﺮﺍﺏ‬ ‫ﻫﻮ‬ ‫ﺍﳌﻨﺎﻋﻲ‬ ‫ﺍﻟﺼﻔﻴﺤﺎﺕ‬ ‫ﻧﻘﺺ‬ ‫ﺍﳋﻼﺻـﺔ:‬ ‫ﺍﻟﺼﻔﻴﺤﺎﺕ‬ ‫ﻧﻘﺺ‬ ‫ﺣﻮﻝ‬ ‫ﺍﻟﺒﺤﻮﺙ‬ ‫ﺍﻟﻮﺭﻗﺔ‬ ‫ﻫﺬﻩ‬ ‫ﻭﺗﺴﺘﻌﺮﺽ‬ ‫ﺍﻟﺪﺧﻞ.‬ ‫ﺍﳌﻨﺨﻔﻀﺔ‬ ‫ﺍﻟﺒﻠﺪﺍﻥ‬ ‫ﰲ‬ ‫ﺍﻧﺘﺸﺎﺭﻩ‬ ‫ﻝ‬ ‫ﻭﻣﻌﺪﱠ‬ ‫ﺍﻻﺿﻄﺮﺍﺏ‬ ‫ﻋﻨﺎﴏ‬ ‫ﻛﺎﻣﻞ‬ ‫ﺗﻌﺪﺍﺩ‬ ‫ﻋﲆ‬ ‫ﻋﺎﺩﺓ‬ ‫ﺍﻟﺘﺸﺨﻴﺺ‬ ‫ﻭﻳﺮﺗﻜﺰ‬ ‫ﺍﻟﺪﺧﻞ.‬ ‫ﻭﺍﳌﺮﺗﻔﻌﺔ‬ ‫ﺍﻟﺪﺧﻞ‬ ‫ﺍﳌﻨﺨﻔﻀﺔ‬ ‫ﺍﻟﺒﻠﺪﺍﻥ‬ ‫ﺑﲔ‬ ‫ﺍﳌﻘﺎﺭﻧﺔ‬ ‫ﻣﻊ‬ ‫ﺍﳌﻨﺎﻋﻲ‬ ‫ﰲ‬ ‫ﻋﺎﻟﻴﺔ‬ ‫ﺍﳌﺮﺽ‬ ‫ﻫﺪﺃﺓ‬ ‫ﻝ‬ ‫ﻭﻣﻌﺪﱠ‬ ‫ﺍﻟﻌﻈﻢ.‬ ‫ﻧﻘﻰ‬ ‫ﺭﺷﺎﻓﺔ‬ ‫ﺩﺭﺍﺳﺔ‬ ‫ﻣﻨﺘﻘﺎﺓ‬ ‫ﺣﺎﻻﺕ‬ ‫ﻭﰲ‬ ‫ﺍﳌﺤﻴﻄﻲ،‬ ‫ﺍﻟﺪﻡ‬ ‫ﻣﻦ‬ ‫ﻟﻄﺎﺧﺔ‬ ‫ﻭﺩﺭﺍﺳﺔ‬ ‫ﺍﻟﺪﻡ‬ ‫ﹶ‬ ‫ﺍﳌﻮﴅ‬ ‫ﺍﳌﻌﺎﳉﺔ‬ ‫ﱠﻞ‬ ‫ﻭﺗﺘﻤﺜ‬ ‫ﺍﻟﻘﺤﻒ.‬ ‫ﺩﺍﺧﻞ‬ ‫ﺑﺎﻟﻨﺰﻑ‬ ‫ﺍﻹﺻﺎﺑﺔ‬ ‫ﺭ‬ ‫ﹾﺪﹸ‬ ‫ﹶﻨ‬ ‫ﻭﺗ‬ ‫ﺍﻟﺪﺧﻞ،‬ ‫ﻭﺍﳌﺮﺗﻔﻌﺔ‬ ‫ﺍﻟﺪﺧﻞ‬ ‫ﺍﳌﻨﺨﻔﻀﺔ‬ ‫ﺍﻟﺒﻠﺪﺍﻥ‬ ‫ﻣﻦ‬ ‫ﻛﻞﹴ‬ ‫ﻣﺘـﺮ‬ ‫ﻣﲇ‬ ‫ﻛﻞ‬ ‫ﰲ‬ ‫ﺻﻔﻴﺤﺔ‬ ‫ﺁﻻﻑ‬ ‫ﻋﴩﺓ‬ ‫ﻣﻦ‬ ‫ﺃﻛﺜﺮ‬ ‫ﺍﻟﺼﻔﻴﺤﺎﺕ‬ ‫ﺗﻌﺪﺍﺩ‬ ‫ﻳﻜﻮﻥ‬ ‫ﻋﻨﺪﻣﺎ‬ ‫ﲈ‬ ‫ﱠ‬ ‫ﻭﻻﺳﻴ‬ ‫ﺍﳊﺎﻻﺕ‬ ‫ﺑﻤﺮﺍﻗﺒﺔ‬ ‫ﺑﺒﺴﺎﻃﺔ‬ ‫ﲠﺎ‬ . ‫ﹰ‬ ‫ﺍﻗﺘﺼﺎﺩﻳﺎ‬ ‫ﻣﻼﺀﻣﺔ‬ ‫ﺍﻷﻛﺜﺮ‬ ‫ﺍﳋﻴﺎﺭ‬ ‫ﻫﻲ‬ ‫ﺍﻟﻔﻤﻮﻳﺔ‬ ‫ﺍﻟﺴﺘﲑﻭﺍﺋﻴﺪﺍﺕ‬ ‫ﻓﺈﻥ‬ ‫ﻟﻠﻤﻌﺎﳉﺔ‬ ‫ﺣﺎﺟﺔ‬ ‫ﻣﻦ‬ ‫ﻫﻨﺎﻟﻚ‬ ‫ﻛﺎﻥ‬ ‫ﻭﺇﺫﺍ‬ ‫ﻣﻜﻌﺐ.‬ Thrombopénie immunologique chez les enfants : le cas des pays à faible revenu RÉSUMÉ La thrombopénie immunologique est un trouble bénin et spontanément résolutif. Les données sur cette maladie et sur son incidence dans les pays à faible revenu sont limitées. Le présent article fait le point sur la recherche dans ce domaine, en comparant les pays à revenu faible et élevé. Le diagnostic repose généralement sur la numération sanguine complète et le frottis sanguin périphérique et, dans certains cas, sur la ponction médullaire. Le taux de rémission de la maladie est important dans les pays à revenu élevé et à faible revenu, et les hémorragies intracrâniennes sont rares. Le traitement recommandé est la simple observation des cas, notamment lorsque le nombre de plaquettes est supérieur à 10 000 /mm3. Si un traitement est nécessaire, les stéroïdes par voie orale constituent la solution la plus économique.

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Bleeding manifestations in severely thrombocytopenic children with immune thrombocytopenic purpura

Cited by 15 publications

References 11 publications

Management of Chronic Childhood Immune Thrombocytopenic Purpura: AIEOP Consensus Guidelines

Management of Chronic Childhood Immune Thrombocytopenic Purpura: AIEOP Consensus Guidelines

Púrpura trombocitopênica imune da criança: experiência de 12 anos em uma única instituição brasileira

Immune thrombocytopenia in children with reference to low income countries

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