Chronic childhood idiopathic thrombocytopenic purpura

Lilleyman, J S

doi:10.1053/beha.2000.0089

Cited by 8 publications

(4 citation statements)

References 65 publications

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“…91,92 ITP refractory to steroids and/or IVIg is uncommon, and should prompt consideration of a congenital thrombocytopenia. 92 Splenectomy is effective in children with ITP with responses seen in 80% 92 and is justified in children with persistent severe thrombocytopenia refractory to other treatments.…”

Section: Childrenmentioning

confidence: 99%

Splenectomy for immune thrombocytopenia: down but not out

Chaturvedi

Arnold

McCrae

2018

Blood

158

154

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word count: 239Word count: 4298 ABSTRACTSplenectomy is an effective therapy for steroid-refractory or dependent immune thrombocytopenia (ITP). With the advent of medical alternatives such as rituximab and thrombopoietin receptor antagonists (TPO-RA), the use of splenectomy has declined and is generally reserved for patients that fail multiple medical therapies. Splenectomy removes the primary site of platelet clearance and autoantibody production, and offers the highest rate of durable response (50-70%) compared to other ITP therapies. However, there are no reliable predictors of splenectomy response, and long-term risks of infection and cardiovascular complications must be considered. Since the long-term efficacy of different second-line medical therapies for ITP have not been directly compared, treatment decisions must be made without supportive evidence. Splenectomy continues to be a reasonable treatment option for many patients, including those with an active lifestyle who desire freedom from medication and monitoring, and patients with fulminant ITP that does not respond well to medical therapy. We try to avoid splenectomy within the first 12 months after ITP diagnosis for most patients to allow for spontaneous or therapy-induced remissions, particularly in older patients who have increased surgical morbidity and lower rates of response, and in young children. Treatment decisions must be individualized based on patients' comorbidities, lifestyles and preferences. Future research should focus on comparing long-term outcomes of patients treated with different second line therapies, and on developing personalized medicine approaches to identify subsets of patients most likely to respond to splenectomy or other therapeutic approaches.

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Section: Childrenmentioning

confidence: 99%

Splenectomy for immune thrombocytopenia: down but not out

Chaturvedi

Arnold

McCrae

2018

Blood

158

154

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“…ITP may be provoked by the measles, mumps and rubella (MMR) vaccine, with an estimated risk of 1 in 24 000 doses (Farrington et al, 1995), usually occurring within 6 weeks of vaccination. There is no evidence of a vaccine‐associated recurrence in children who developed ITP independently of and before MMR vaccination (Miller et al , 2001). The Committee on the Safety of Medicines (CSM) recommend that children who develop ITP within 6 weeks of the first dose of MMR should have their serological status for the three viruses evaluated before the second dose is due.…”

Section: Diagnosismentioning

confidence: 99%

Guidelines for the investigation and management of idiopathic thrombocytopenic purpura in adults, children and in pregnancy

Provan¹,

Newland²,

Norfolk³

et al. 2003

Br J Haematol

692

105

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“…ITP in children, particularly in the first decade of life, is less likely to present with significant bleeding or to be associated with an underlying disorder, and more likely to remit spontaneously. 11,12 This narrative review summarizes the epidemiology and clinical manifestations of ITP in the adult and paediatric populations.…”

Section: Introductionmentioning

confidence: 99%

Epidemiology and Clinical Manifestations of Immune Thrombocytopenia

Kohli

Chaturvedi

2019

Hamostaseologie

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Immune thrombocytopenia (ITP) occurs with an incidence rate of 1.6 to 3.9 per 100,000 patient-years, which increases with age and has a slight female preponderance. ITP is termed acute, persistent or chronic when its duration is <3 months, 3 to 12 months and >12 months, respectively. In this narrative review, we discuss the clinical manifestations of ITP in children and adults. ITP is asymptomatic in some patients; however, when present, bleeding is the most common symptom and can be mild as in petechiae, purpura and epistaxis, or severe and even life threatening in cases of intracranial haemorrhage, and massive gastrointestinal or urinary tract bleeding. A platelet count <10–20 × 109/L, advanced age and prior minor bleeding are risk factors for major bleeding, which is also more common in the months following a new diagnosis of acute ITP. Fatigue and impaired health-related quality of life are also manifestations of ITP that often improve with treatment and improvement in platelet counts. Over long-term follow-up, ITP is also associated with an increased risk of venous and arterial thromboembolism, haematologic malignancy and overall mortality than the general population.

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Chronic childhood idiopathic thrombocytopenic purpura

Cited by 8 publications

References 65 publications

Splenectomy for immune thrombocytopenia: down but not out

Splenectomy for immune thrombocytopenia: down but not out

Guidelines for the investigation and management of idiopathic thrombocytopenic purpura in adults, children and in pregnancy

Epidemiology and Clinical Manifestations of Immune Thrombocytopenia

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