The Role of the Bone Marrow Examination in the Diagnosis of Immune Thrombocytopenic Purpura: Case Series and Literature Review

Jubelirer, Steven; R, Harpold

doi:10.1177/107602960200800110

Cited by 69 publications

(53 citation statements)

References 11 publications

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“…According to the American Society of Hematology (1996), the diagnosis of ITP can be made on the basis of a thorough history and physical examination and a complete blood cell count, including the examination of a peripheral blood smear [3]. A number of studies support the idea that it is not necessary to routinely perform bone marrow examination for the diagnosis of ITP [4].…”

Section: Introductionmentioning

confidence: 99%

Immature Platelet Fraction: Establishment of a Reference Interval and Diagnostic Measure for Thrombocytopenia

et al. 2010

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451Background: Immature platelet fraction (IPF, %) is a measure of reticulated platelets (RPs), which represents the state of thrombopoiesis. The IPF is obtained from an automated hematology analyzer as one of the platelet parameters. This study was performed to establish reference intervals of IPF and its cut-off values for the differential diagnosis of thrombocytopenia.Methods: Blood samples from 2,039 healthy individuals (1,161 males, 878 females) were obtained to establish reference intervals. The patient group included patients with idiopathic thrombocytopenic purpura (ITP) (N=150) and aplastic anemia (AA) (N=51) with platelet counts of less than 100×10 9 /L. We evaluated the reliability of the IPF measurements, the reference intervals, and cut-off value for the diagnosis of ITP.Results: The reference intervals of IPF were 0.5-3.2% in males and 0.4-3.0% in females (95% confidence interval). The median IPF% of ITP and AA were 7.7% (range, 1.0-33.8%) and 3.5% (range, 0.6-12.9%), respectively. Statistical analysis revealed a significant difference between the IPF% of ITP and AA (P<0.0001). The cut-off value of IPF for differentiating ITP from AA was 7.3% with a sensitivity and specificity of 54.0% and 92.2%, respectively.Conclusions: A rapid and inexpensive automated measurement of IPF can be integrated as a standard parameter to evaluate the thrombopoietic state of the bone marrow. This study determined the reference intervals of IPF from a large population of healthy individuals, including children. Further studies are needed to establish the clinical utility of IPF. (Korean J Lab Med 2010;30:451-9)

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Section: Introductionmentioning

confidence: 99%

Immature Platelet Fraction: Establishment of a Reference Interval and Diagnostic Measure for Thrombocytopenia

et al. 2010

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“…In ITP, the bone marrow is normocellular with increased or normal numbers of megakaryocytes and unremarkable erythropoiesis and granulopoiesis 98,99 . Rarely, megakaryocytes are decreased 98 .…”

Section: Thrombocytopeniamentioning

confidence: 99%

The pathology of bone marrow failure

Leguit

Tweel

2010

Histopathology

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Leguit R J & van den Tweel J G (2010) Histopathology 57, 655–670 The pathology of bone marrow failure An important indication for bone marrow investigation is the presence of bone marrow failure, which manifests itself as (pan)cytopenia. The causes of cytopenia are varied and differ considerably between childhood and adulthood. In the paediatric age group inherited bone marrow failure syndromes are important causes of bone marrow failure, but they play only a minor role in later life. This review gives a comprehensive overview of bone marrow failure disorders in children and adults. We classified the causes of bone marrow failure according to the main presenting haematological abnormality, i.e. anaemia, neutropenia, thrombocytopenia or pancytopenia. The following red cell disorders are discussed: red cell aplasia, sideroblastic anaemia, congenital dyserythropoietic anaemia, haemolytic anaemia, paroxysmal nocturnal haemoglobinuria, iron deficiency anaemia, anaemia of chronic disease and megaloblastic anaemia. The neutropenias occur in the context of Shwachman–Diamond syndrome (SDS), severe congenital neutropenia, cyclic neutropenia, immune‐related neutropenia and non‐immune neutropenia. In addition, the following causes of thrombocytopenia are discussed: congenital amegakaryocytic thrombocytopenia, thrombocytopenia with absent radii, immune‐related thrombocytopenia and non‐immune thrombocytopenia. Finally, we pay attention to the following pancytopenic disorders: Fanconi anaemia, dyskeratosis congenita, aplastic anaemia, myelodysplastic syndromes and human immunodeficiency virus (HIV) infection.

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“…[58][59][60] The diagnosis of ITP is made by exclusion of secondary causes of thrombocytopenia (Table 2) as there are no diagnostic tests to confirm ITP. The initial history and physical examination should be aimed at identifying evidence of bleeding and excluding other causes of thrombocytopenia or secondary ITP.…”

Section: Question: What Testing Is Required To Confirm the Diagnosis mentioning

confidence: 99%

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

Neunert

Lim

Crowther

et al. 2011

Blood

1,648

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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The Role of the Bone Marrow Examination in the Diagnosis of Immune Thrombocytopenic Purpura: Case Series and Literature Review

Cited by 69 publications

References 11 publications

Immature Platelet Fraction: Establishment of a Reference Interval and Diagnostic Measure for Thrombocytopenia

Immature Platelet Fraction: Establishment of a Reference Interval and Diagnostic Measure for Thrombocytopenia

The pathology of bone marrow failure

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

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