Prognostic Factors for Immune Thrombocytopenia Outcome in Greek Children: A Retrospective Single-Centered Analysis

Makis, Alexandros; Gkoutsias, Athanasios; Palianopoulos, Theodoros; Pappa, Eleni; Papapetrou, Evangelia; Tsaousi, Christina; Hatzimichael, Eleftheria; Chaliasos, Nikolaos

doi:10.1155/2017/7878605

Cited by 11 publications

(16 citation statements)

References 28 publications

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“…Jung et al reported that 85.9% of children with ITP would have remission and 14.1% would have chronic ITP; the prognostic factors for chronic ITP are children of an older age and the slow appearance of clinical symptoms [ 27 ]. Makis et al reported that the prognostic factors for developing chronic ITP are age >10 years, no previous infection history, longer duration of clinical manifestations, and initial platelet count >10 000/uL [ 28 ]. Other investigators reported that the prognostic factors that provided complete remission when ITP was established were a low mean platelet volume level <8 fL and previous infection history [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Megadose Methylprednisolone for Immune Thrombocytopenia in an Infant Positive for SARS-CoV-2: A Case Report

Ringoringo

Hartoyo

2021

Am J Case Rep

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Patient: Male, 9-month-old Final Diagnosis: Newly diagnosed ITP Symptoms: Petechiae on the forehead • cheeks • mouth • extremities. The patient is febrile, had rhinorrhea for three days previously. The patient is pale, weak, cannot drink Medication: — Clinical Procedure: The patient had immunizations of the Measles-Rubella vaccine 19 days before. Physical examination: Eye, ENT, and mouth, no abnormalities. Heart and Lungs within normal limits. Abdomen: there was no organomegaly – there neither lymphadenopathy nor a congenital anomaly Specialty: Hematology • Infectious Diseases • Pediatrics and Neonatology Objective: Rare coexistence of disease or pathology Background: Immune thrombocytopenia (ITP) is rare in infants under 1 year old. Bleeding often occurs when the platelet count is <20 000/uL. The disease can progress because of accompanying COVID-19 disease. Case Report: A 9-month-old boy, weighing 8.5 kg, came to the hospital with petechiae on the forehead, cheeks, mouth, and extremities. The patient had rhinorrhea for 3 days previously and was febrile, pale, weak, and could not drink. He had the measles-rubella vaccination 19 days prior. Physical examination showed no abnormalities of the eyes, ears, nose, throat, and mouth. Heart and lungs were within normal limits, with no organomegaly, lymph-adenopathy, or congenital anomaly of the abdomen. Laboratory examination showed hemoglobin, 12.7 g/dL; leukocytes, 7420/uL; platelet count, 16 000/uL; and hematocrit, 37.9%. Erythrocyte sedimentation rate was 14 mm at 1 h and 21 mm at 2 h. Peripheral blood smear showed normal RBC morphology, normal leukocytes, and few platelets. IgG was reactive and IgM was nonreactive on rapid antibody test. RT-PCR was positive for SARS-COV-2. Chest-X-ray showed pneumonia. The diagnosis was newly diagnosed ITP with COVID-19. Patient was treated with 30 mg/kg body weight/day of IV methylprednisolone for 3 days (250 mg); then 20 mg/kg body weight/day (175 mg) orally for 4 days in 3 divided doses. Azithromycin 100 mg/day, zinc 20 mg/day, and vitamin C 50 mg/day orally were also given. Conclusions: COVID-19 screening is highly recommended during this pandemic to identify it as a potential cause of childhood ITP. Megadose methylprednisolone had an excellent response in alleviating ITP with confirmed COVID-19 in an infant.

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Section: Discussionmentioning

confidence: 99%

Megadose Methylprednisolone for Immune Thrombocytopenia in an Infant Positive for SARS-CoV-2: A Case Report

Ringoringo

Hartoyo

2021

Am J Case Rep

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“…Similarly, sex, age, and platelet counts were considered as important risk factors for chronic disease in our study. In another study, Makis et al examined the relationship of different risk factors with the development of chronic ITP in 57 children [12]. Multiple logistic regression models were used to investigate the association of age, sex, history of infection, type of bleeding, duration of symptoms, platelet count at diagnosis, treatment process, and immunological markers with chronic ITP.…”

Section: Discussionmentioning

confidence: 99%

“…Current treatment of ITPs includes the use of IVIG or steroids, anti-D, and in some cases only the patient is monitored [9]. Old age, female gender, and the onset of disease, silence have been suggested as risk factors for chronic disease [10], [11], [12], but unfortunately it is unclear, which what is the relationship between disease time and the number of bone marrow megakaryocytes. Given the absence of a standard for the chronic type ITP, identifying the risk factors involved in the onset and early diagnosis of the disease is very valuable.…”

Section: Introductionmentioning

confidence: 99%

“…Given the absence of a standard for the chronic type ITP, identifying the risk factors involved in the onset and early diagnosis of the disease is very valuable. Although several studies have examined the risk factors associated with the chronic state of ITP disease [10], [11], [12], early diagnosis of the disease remains a major concern. Therefore, research on finding predictive patterns of various risk factors related to chronic disease is very valuable and will greatly help in diagnosis, appropriate treatment of disease and reduction of the economic burden of society.…”

Section: Introductionmentioning

confidence: 99%

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Predictive Value of Risk Factors for Chronic Idiopathic Thrombocytopenic Purpura in Patients with Acute Type of Disease

Bahoush

Ghasemi

Razavi

et al. 2020

Open Access Maced J Med Sci

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BACKGROUND: Immune thrombocytopenic purpura (ITP) is an autoimmune disease in which autoantibodies react with platelet surface antigens and results in mild to severe thrombocytopenia due to decreased platelet count or inhibition of platelet production. Given the relatively high prevalence of ITP among children and the lack of standard diagnostic testing for the diagnosis of chronic disease, this study evaluated the predictive value of risk factors for chronic ITP in hospitalized patients. METHODS: This prospective cohort study was performed on 65 children with ITP who referred to Ali Asghar and Rasool Akram Hospitals in Tehran, Iran, during the years 2017 and 2018. Relationships between different risk factors, including age of diagnosis, gender, white cell count, primary platelet count, mean platelet volume (MPV), history and type of the previous patient infection, FCG gene mutation, and type of FCG mutation with a chronic disease incidence were investigated using multiple logistic regression model. RESULTS: Of 65 patients, 31 (47.69%) were male and 34 (52.31%) were female included in the study. Twenty-eight patients (43.08%) had acute ITP and 37 (56.92%) had chronic ITP. Frequency of FCG gene mutation in patients with chronic and acute type ITP was 16.36% and 7.27%, respectively (p = 0.51). No association was found between the history of the previous infection and its type with the chronic incidence of ITP. The multiple logistic regression model showed that three factors, including the absolute number of lymphocytes, age of diagnosis, and primary white blood cells (WBC) count were directly linked to chronic ITP. Furthermore, three factors of platelet, sex, and MPV were indirectly related to chronic ITP. In addition, the absolute number of lymphocytes, age of diagnosis and primary WBC count were significantly associated with chronic ITP. The receiver operating characteristic analysis showed that the cutoff rate of these factors was 0.31. Further analysis of these risk factors in comparison with the gold standard demonstrated that the diagnostic sensitivity and specificity of these risk factors for chronic ITP were 73.08% and their specificity was 88.57%, indicating the high importance and predictive power of these risk factors. CONCLUSIONS: According to the results of this study, for the first time in Iran, six risk factors, including the absolute number of lymphocytes, age at diagnosis, sex, MPV level, platelet level at time of diagnosis, and primary WBC count were considered as the most important risk factors affecting the incidence of chronic ITP. Of course, more comprehensive studies can definitely lead to more comprehensive models.

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“…Additionally, 2 observational studies in children have referred to the association of platelets with ITP, but the results were inconsistent. One of the studies found that persistent ITP had a significantly lower initial platelet count compared with newly diagnosed ITP [29]; another study concluded that initial platelet count was not associated with GC resistance [30]. Therefore, in view of the aforementioned evidence, we used the ratio of the 2 to observe their association with GC resistance.…”

Section: Discussionmentioning

confidence: 99%

Platelet to Lymphocyte Ratio and Glucocorticoid Resistance in Newly Diagnosed Primary Immune Thrombocytopenia: A Retrospective Cohort Study

et al. 2019

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Background: In China, evidence regarding to the association between platelet to lymphocyte ratio (PLR) and glucocorticoid (GC) resistance in participants with primary newly identified immune thrombocytopenia (ITP) is limited. We aimed to investigate whether PLR is independently linked with GC-resistant ITP. Material/Methods: We non-selectively and consecutively collected 154 newly diagnosed ITPs. The start enrollment time and the end enrollment time were from March 2013 to June 2017. The independent and dependent variables were PLR measured at diagnosis and GC non-response. Other variables involved in the present work can be summarized as demographic data and factors that were correlated with PLR reported by published studies. Univariate and multivariate binary logistic regression model and sensitivity analysis were used to evaluate the associations between PLR and GC resistance. Results: After adjusting covariates, PLR level was negatively associated with GC non-response [odds ratio (OR)=0.89, 95% confidence intervals (CI): 0.80 to 0.98], and supported by propensity score matching model (OR=0.74, 95%CI: 0.57 to 0.96]. Nonlinearity of PLR and GC resistance was observed whose inflection point was 5.08 (by 2-piecewise model). The OR and 95%CI on both sides of inflection point were 3.14 (0.81 to 12.21) and 0.81 (0.69 to 0.95), respectively. Subgroup analysis showed no significant differences from subgroups. Conclusions: Threshold effect on PLR and GC resistance is observed. When PLR is larger than 5.08, a unit increase of PLR is independently associated with 19% reduction of GC resistance.

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Prognostic Factors for Immune Thrombocytopenia Outcome in Greek Children: A Retrospective Single-Centered Analysis

Cited by 11 publications

References 28 publications

Megadose Methylprednisolone for Immune Thrombocytopenia in an Infant Positive for SARS-CoV-2: A Case Report

Megadose Methylprednisolone for Immune Thrombocytopenia in an Infant Positive for SARS-CoV-2: A Case Report

Predictive Value of Risk Factors for Chronic Idiopathic Thrombocytopenic Purpura in Patients with Acute Type of Disease

Platelet to Lymphocyte Ratio and Glucocorticoid Resistance in Newly Diagnosed Primary Immune Thrombocytopenia: A Retrospective Cohort Study

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