Intended management of children with acute idiopathic thrombocytopenic purpura: A national survey

Marks, MK; Vadamalayan, Babu; Ekert, H; South, Mike

doi:10.1111/j.1440-1754.2005.00536.x

Cited by 11 publications

(8 citation statements)

References 14 publications

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“…Most American pediatric hematology/oncology specialists perform a bone marrow aspirate when corticosteroids are prescribed. In contrast, Australian pediatricians were less likely to examine the bone marrow if corticosteroids were prescribed [13,14]. Bone marrow examination led to an alternate diagnosis in 3.9 % of 127 children in one study [15].…”

Section: Discussionmentioning

confidence: 99%

Re-evaluation of Need for Bone Marrow Examination in Patients with Isolated Thrombocytopenia Contributors

Purohit

Aggarwal

Singh

et al. 2015

Indian J Hematol Blood Transfus

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Diagnosis of immune thrombocytopenia (ITP) is based on clinical suspicion and normal peripheral smear except for thrombocytopenia. Bone marrow examination is carried out to rule out leukemia, myelodysplastic syndrome or aplastic anemia. However, in most cases, clinical diagnosis is not altered after the bone marrow reports. Hence, this present study was carried out to evaluate the justification for bone marrow examination in the setting of isolated thrombocytopenia. All patients presenting to the hematology OPD with isolated thrombocytopenia and suspected diagnosis of ITP, between October 2011 and April 2013, were included in the study. Data was collected from bone marrow reports and outpatient records. A total of 353 cases were found. 319 cases had features of typical ITP and the rest had some form of organomegaly and/or lymphadenopathy. Bone marrow examination in all cases revealed normal hematopoietic elements and prominence of megakaryocytes including juvenile forms with no novel diagnosis in any patient. Routine use of bone marrow examination in the diagnostic workup of isolated thrombocytopenia is not required in our center even if steroids are planned as a first line therapy. However, a detailed history, thorough examination with complete hemogram and peripheral smear examination are essential.

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Section: Discussionmentioning

confidence: 99%

Re-evaluation of Need for Bone Marrow Examination in Patients with Isolated Thrombocytopenia Contributors

Purohit

Aggarwal

Singh

et al. 2015

Indian J Hematol Blood Transfus

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“…Previously published data concerning treatment options in other countries indicated very variable percentages with regard to both observation and pharmacotherapy, including drugs like anti-D immunoglobulins which were not available in Italy when the guidelines were drawn up [6, 9, 11, 12, 21, 24, 25]. For these reasons our data cannot be strictly compared with others.…”

Section: Discussioncontrasting

confidence: 47%

“…More recent data report a lower hospitalization rate, and the common practice is to avoid hospitalization until it is actually necessary [3, 8, 9, 12]. However, no controlled studies have evaluated the real effectiveness of hospitalization [15], and all published guidelines provide different instructions.…”

Section: Discussionmentioning

confidence: 99%

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Management of Acute Childhood Idiopathic Thrombocytopenic Purpura according to AIEOP Consensus Guidelines: Assessment of Italian Experience

et al. 2008

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Background: Consensus guidelines for diagnosis and treatment of acute childhood idiopathic thrombocytopenic purpura (ITP) were published in 2000 by the Italian Association of Pediatric Haematology and Oncology (AIEOP). The assessment of guideline implementation was the primary objective of the present study. Patients and Methods: Information on each newly diagnosed case of ITP referring to centres conforming with the guidelines was obtained by a questionnaire. Results: Data concerning 609 new cases of acute childhood ITP were collected including 346 (56.8%) asymptomatic-paucisymptomatic forms (type A), 262 (43%) intermediate clinical forms (type B), and 1 (0.2%) severe form (type C). At diagnosis, 82% of cases were hospitalized. Age, platelet count and duration of hospitalization were significantly different in type A and type B cases. Of the total number of cases, 25% were kept under observation, 38.6% received intravenous immunoglobulins, 23.9% oral or parenteral steroids, and 12.7% other treatments. The initial treatment turned out to be appropriate for 428 cases (72.2%), of uncertain appropriateness in 71 (11.9%), and inappropriate in 95 cases (15.9%). The total level of implementation was 84.1%. Conclusions: A high rate of guideline implementation was observed during the study period. The guidelines should be reviewed taking into account more recent evidence.

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“…Determination of the risk factors for developing chronic ITP and the prognosis for chronic ITP are issues for discussion among pediatric hematologists. The first issue has been well investigated and has been reported from European [5,6], North American [7,8], Oceanian [9], and Asian countries [10,11]. Although there is some consistency among these reports, one can also find differences among these reports presumably due to differences in the study designs and populations.…”

Section: Introductionmentioning

confidence: 93%

Characterization of chronic idiopathic thrombocytopenic purpura in Japanese children: a retrospective multi-center study

et al. 2010

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The objectives of this study are to clarify (1) the difference in demographic and clinical variables at initial presentation between acute and chronic idiopathic thrombocytopenic purpura (ITP), and (2) the prognostic factors of patients with chronic ITP. We conducted a retrospective analysis of 247 children with newly diagnosed ITP between April 1991 and March 2006 who visited one of the 12 hospitals belonging to the Kyoto University Pediatric Hematologic Study Group. 180 and 67 cases were classified as the acute type and as the chronic type, respectively. Older age, higher initial platelet count, positive medical history or concomitant medical diagnosis, the absence of preceding infection or vaccination, and the absence of an increase in immunoglobulin were risk factors for the chronicity. The prognostic factors in chronic ITP were evaluated in 53 patients after excluding patients receiving splenectomy or having insufficient follow-up data. The overall time required for 50% resolution in patients with chronic ITP was approximately 5.6 years. Age at presentation of less than 3 years and higher platelet counts at the time of chronic ITP diagnosis were good prognostic factors. On the other hand, gender, initial platelet counts, and preceding infection or vaccination were not associated with the prognosis.

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Intended management of children with acute idiopathic thrombocytopenic purpura: A national survey

Cited by 11 publications

References 14 publications

Re-evaluation of Need for Bone Marrow Examination in Patients with Isolated Thrombocytopenia Contributors

Re-evaluation of Need for Bone Marrow Examination in Patients with Isolated Thrombocytopenia Contributors

Management of Acute Childhood Idiopathic Thrombocytopenic Purpura according to AIEOP Consensus Guidelines: Assessment of Italian Experience

Characterization of chronic idiopathic thrombocytopenic purpura in Japanese children: a retrospective multi-center study

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