Misdiagnosis of primary immune thrombocytopenia and frequency of bleeding: lessons from the McMaster ITP Registry

Arnold, Donald M.; Nazy, Ishac; Clare, Rumi; Jaffer, Anushka; Aubie, Brandon; Li, Na; Kelton, John G.

doi:10.1182/bloodadvances.2017010942

Cited by 104 publications

(108 citation statements)

References 23 publications

(29 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Patients were identified from the McMaster ITP Registry, a prospective, longitudinal observation study of consecutive adults referred for thrombocytopenia. 10 ITP was defined per established guidelines. 11 We identified all ITP patients with platelet counts ,50 3 10 9 /L who were receiving anticoagulation for any indication.…”

mentioning

confidence: 99%

Managing antithrombotic therapy in immune thrombocytopenia: development of the TH2 risk assessment score

Balitsky¹,

Kelton

Arnold

2018

Blood

Self Cite

View full text Add to dashboard Cite

mentioning

confidence: 99%

Managing antithrombotic therapy in immune thrombocytopenia: development of the TH2 risk assessment score

Balitsky¹,

Kelton

Arnold

2018

Blood

Self Cite

View full text Add to dashboard Cite

“…The rate of secondary ITP in adults in our survey is consistent with those of other studies (18-25.7%). 2,23,24 However, the distribution of causes of secondary ITP in children and adults significantly differed from that reported in France. 2 The findings of higher HCV and HBV and lower human immunodeficiency virus as causes of secondary ITP in Taiwan compared with France are consistent with variations in prevalence rates of these infectious diseases in these two regions.…”

Section: Discussionmentioning

confidence: 85%

Incidence of immune thrombocytopenia in Taiwan: a nationwide population‐based study

et al. 2018

View full text Add to dashboard Cite

BACKGROUND The incidence of immune thrombocytopenia (ITP) is not well known in Asians. The aims of this study were to survey incidences and clinical features of ITP in Taiwan. STUDY DESIGN AND METHODS This study identified 4855 incident ITP cases from the population‐based National Health Insurance Research Database from mid‐2006 to mid‐2013, and compared incidences, patient characteristics, and clinical manifestations of ITP by age. RESULTS Respective ITP incidence rates among those aged <15, 15 to 59, and ≥60 years were 4.0, 2.0, and 5.4 per 100,000 person‐years. A male predominance was noted in children, and a female predominance was found in adults. The most common causes of secondary ITP were systemic lupus erythematosus (21.8%), viral hepatitis C (16.9%), and viral hepatitis B (13.4%). The rate of secondary ITP in children was less than one fifth that in adults (4.2% vs. 23.8%). Rates of central nervous system (1.1%) and gastrointestinal tract bleeding (3.3%) were rare, with variations by age. The rate of splenectomies in children (0.4%) was only one tenth that in adults (4.1%). The disease in 25% of children and 30% of adults became persistent or chronic. A decreasing trend in the ITP incidence was found (annual percentage change, −4.9%), and it was confined to those aged >15 years. CONCLUSION Incidence estimates of ITP in Taiwan were close to those of Western countries, with age‐specific variations in sex ratio, comorbidity, splenectomy, secondary causes, and incidence trends. The results suggest no racial variations in ITP incidences, but a geographical difference in causes of secondary ITP.

show abstract

“…One recent study estimated that nearly one in seven patients who are initially diagnosed with ITP are later found to have another cause for their thrombocytopenia, indicating that a high index of suspicion for other diagnoses should be maintained. 17 In the pediatric population, genetic causes of thrombocytopenia should be considered, especially if there is a positive family history of thrombocytopenia and/or accompanying laboratory abnormalities that are not fully explained by ITP. For example, isolated thrombocytopenia is sometimes the initial presenting symptom in patients with inherited bone marrow failure syndromes, such as Fanconi anemia or congenital amegakaryocytic thrombocytopenia.…”

Section: Discussionmentioning

confidence: 99%

Macrothrombocytopenia associated with a rare GFI1B missense variant confounding the presentation of immune thrombocytopenia

Cheng

Bao

Fiorini

et al. 2019

Pediatric Blood & Cancer

View full text Add to dashboard Cite

Growth factor‐independent 1B (GFI1B) variants are a rare cause of thrombocytopenia. We report on a male child who was initially diagnosed with immune thrombocytopenia. However, subtle clinical signs led to suspicion of a genetic cause of thrombocytopenia. Gene panel sequencing revealed a rare variant in GFI1B (C168F), which has recently been reported in several families with thrombocytopenia. We demonstrate that this variant significantly alters platelet parameters in population studies. This case highlights how diagnoses of exclusion, such as immune thrombocytopenia, can be confounded by genetic variation. Our understanding of blood disorders will undoubtedly evolve from an increased knowledge of human genetic variation.

show abstract

Misdiagnosis of primary immune thrombocytopenia and frequency of bleeding: lessons from the McMaster ITP Registry

Abstract: Key Points One in 7 patients suspected of having primary ITP was misdiagnosed at some point during their disease course; 56.1% had grade 2 bleeding. The McMaster ITP Registry is a useful tool to improve the diagnosis of ITP and identify unique subgroups of patients.

Cited by 104 publications

References 23 publications

Managing antithrombotic therapy in immune thrombocytopenia: development of the TH2 risk assessment score

Managing antithrombotic therapy in immune thrombocytopenia: development of the TH2 risk assessment score

Incidence of immune thrombocytopenia in Taiwan: a nationwide population‐based study

Macrothrombocytopenia associated with a rare GFI1B missense variant confounding the presentation of immune thrombocytopenia

Contact Info

Product

Resources

About