Duration and morbidity of newly diagnosed idiopathic thrombocytopenic purpura in children: a prospective nordic study of an unselected cohort

Rosthøj, Steen; Hedlund-Treutiger, Iris; Rajantie, Jukka; Zeller, Bernward; Jónsson, Òlafur G.; Elinder, Göran; Wesenberg, Finn; Henter, Jan‐Inge

doi:10.1067/s0022-3476(03)00245-2

Cited by 115 publications

(107 citation statements)

References 12 publications

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“…Similarly Rosthjo et al and Zeller et al found that the development of chronic disease was influenced by age. 18,19 Whereas this data suggest that adolescents are more likely than younger children to develop persistent or chronic disease, there have been no studies investigating a benefit to altered treatment in this age group or the age at which this effect is likely to be most present. Therefore the management of adolescents should follow the usual management of children with ITP.…”

Section: Question: Do You Treat This Child With Medication At This Time?mentioning

confidence: 69%

“…Data from natural history investigations, however, suggest that adolescents might be more likely to develop persistent or chronic ITP. 18,19,26 The study by Kuhne et al described above showed that the rate of chronic disease, defined by a platelet count Ͻ 150 ϫ 10 9 /L at 6 months, was more common in older children. 19 The percentages of children with chronic ITP were 23.1% for children age Ͼ 3 months to Ͻ 12 months, 28.1% for children Ͼ 12 months and Ͻ 10 years, and 47.3% for children Ͼ 10 years (P Ͻ .001 for the comparison of rates between those Ͻ 12 months, with those Ͼ 10 years).…”

Section: Question: Do You Treat This Child With Medication At This Time?mentioning

confidence: 99%

“…18,19 Rosthøj et al reported more than 500 children with a platelet count Ͻ 30 ϫ 10 9 /L at diagnosis followed for 6 months and found no episodes of ICH or life-threatening bleeding. 18 A registry of 2540 children followed for 6 months reported 3 episodes (0.17%) of ICH. 19 All 3 patients had a platelet count Ͻ 20 ϫ 10 9 /L at diagnosis and 2 of the 3 had received treatment at diagnosis.…”

Section: Question: Do You Treat This Child With Medication At This Time?mentioning

confidence: 99%

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The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia

Neunert

Lim

Crowther

et al. 2011

Blood

1,620

1,783

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Immune thrombocytopenia (ITP) is commonly encountered in clinical practice. In 1996 the American Society of Hematology published a landmark guidance paper designed to assist clinicians in the management of this disorder. Since 1996 there have been numerous advances in the management of both adult and pediatric ITP. These changes mandated an update in the guidelines. This guideline uses a rigorous, evidence-based approach to the location, interpretation, and presentation of the available evidence. We have endeavored to identify, abstract, and present all available methodologically rigorous data informing the treatment of ITP. We provide evidence-based treatment recommendations using the GRADE system in those areas in which such evidence exists. We do not provide evidence in those areas in which evidence is lacking, or is of lower quality-interested readers are referred to a number of recent, consensus-based recommendations for expert opinion in these clinical areas. Our review identified the need for additional studies in many key areas of the therapy of ITP such as comparative studies of "front-line" therapy for ITP, the management of serious bleeding in patients with ITP, and studies that will provide guidance about which therapy should be used as salvage therapy for patients after failure of a first-line intervention. (Blood. 2011;117(16):4190-4207)

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Section: Question: Do You Treat This Child With Medication At This Time?mentioning

confidence: 69%

Section: Question: Do You Treat This Child With Medication At This Time?mentioning

confidence: 99%

Section: Question: Do You Treat This Child With Medication At This Time?mentioning

confidence: 99%

See 1 more Smart Citation

The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia

Neunert

Lim

Crowther

et al. 2011

Blood

1,620

1,783

View full text Add to dashboard Cite

show abstract

“…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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“…In the remaining 20% of cases, thrombocytopenia is still present 6 months after the diagnosis; thus, the disease is classified as chronic [1][2][3][4][5]. A higher risk of developing a chronic ITP appears to be associated with female gender, age at diagnosis older than 10 years, and PLT count at diagnosis above 20.000/μl [6,7].…”

Section: Introductionmentioning

confidence: 99%

Chronic Idiopathic Thrombocytopenic Purpura in children: predictive factors and outcome

Coccia¹,

Ruggiero²,

Attinà³

et al. 2012

Open Medicine

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AbstractIdiopathic thrombocytopenic purpura (ITP) is the most common cause of acquired thrombocytopenia in children. In 20% of cases, this condition is classified as chronic when the thrombocytopenia is persistent 6 months after diagnosis. The aim of the present study is to identify the potential factors correlating with a favorable outcome in patients with chronic ITP. Some 71 patients affected by ITP were retrospectively analyzed. Results show a higher rate of spontaneous recovery that is statistically significant for patients with platelet count at diagnosis <20,000/µL. These observations suggest the possibility to delay or avoid aggressive surgical treatment for these patients.

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Duration and morbidity of newly diagnosed idiopathic thrombocytopenic purpura in children: a prospective nordic study of an unselected cohort

Cited by 115 publications

References 12 publications

The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia

The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia

Occult hemorrhage in children with severe ITP

Chronic Idiopathic Thrombocytopenic Purpura in children: predictive factors and outcome

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