Controversies in the Management of Acute Idiopathic Thrombocytopenic Purpura: A Survey of Specialists

PEDIATRICS ◽  
1986 ◽  
Vol 77 (1) ◽  
pp. 49-52
Author(s):  
A. Stephen Dubansky ◽  
Frank A. Oski
Keyword(s):  
Bone Marrow ◽  
Idiopathic Thrombocytopenic Purpura ◽  
Bone Marrow Examination ◽  
Thrombocytopenic Purpura ◽  
Pediatric Hematology ◽  
Do So

A total of 322 physicians, Board-certified in pediatric hematology, responded to a survey designed to determine several aspects of their management of children with acute idiopathic thrombocytopenic purpura. The survey demonstrates that, in practice among specialists, a controversy exists as to whether or not bone marrow examination needs to be performed, and how often corticosteroids should be prescribed. Seventy-four percent of practitioners would perform the bone marrow examination, whereas 26% would not do so. Forty-six percent of responders prescribe steroids more than half the time, whereas 54% prescribe steroids less than half the time. The questionnaire ascertained the reasons why physicians performed marrow aspirations and prescribed steroids.

Bone Marrow Examination in Childhood Idiopathic Thrombocytopenic Purpura: Is it Routinely Indicated?

1992 ◽  
Vol 12 (2) ◽  
pp. 229-230
Author(s):  
Helmy A. Qurtom ◽  
Qusay A. Al-Saleh ◽  
Mahmoud M. Lubani ◽  
Hamdy M. Aboel-Hassan ◽  
Pediatrics Huda Omar
Keyword(s):  
Bone Marrow ◽  
Idiopathic Thrombocytopenic Purpura ◽  
Bone Marrow Examination ◽  
Thrombocytopenic Purpura

Presentation and Outcome of Idiopathic Thrombocytopenic Purpura in Children: A Single Institution Experience

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4683-4683
Author(s):  
Kari Bradham ◽  
Felicia L. Wilson ◽  
Hamayun Imran
Keyword(s):  
Bone Marrow ◽  
Platelet Count ◽  
Idiopathic Thrombocytopenic Purpura ◽  
Conflicts Of Interest ◽  
Laboratory Data ◽  
Bone Marrow Examination ◽  
Published Data ◽  
Thrombocytopenic Purpura ◽  
Chronic Itp ◽  
Increased Risk

Abstract Abstract 4683 PURPOSE: To review the presenting features, response to treatment and outcome in children diagnosed with idiopathic thrombocytopenic purpura (ITP) at the University of South Alabama, Children’s and Women’s Hospital and Specialty Clinic. METHODS: Using ICD code 287.3, data were collected from the specialty clinic’s medical records and hospital database for children diagnosed with ITP between January 2005 and September 2010. Recurrent and chronic ITP were defined as thrombocytopenia recurring within or more than 6 months of diagnosis, respectively. Univariate and multivariate logistic regression analyses were performed to evaluate variables associated with chronic ITP. RESULTS: Eight four patients were identified (M,F 1:1) with an average age of 70 months at diagnosis. Mean platelet count at presentation was 14k. Oral or nasal mucosal bleeding occurred in 19(23%) patients but none experienced a serious hemorrhage. Thirty three (39%) patients had an associated illness prior to diagnosis of ITP. Treatment consisted of intravenous immunoglobulin (IVIG) in 38(45%), WinRho in 11(13%), IVIG or WinRho followed by the other in 20(24%), data not available 8(10%) and no therapy in 7 patients (8%). Average platelet count at discharge and within 2 weeks after IVIG and WinRho was 57k, 337k and 57k, 375 respectively. Forty three (51%) were acute, 17(20%) became recurrent, and 24(29%) became chronic ITP. Bone marrow examination was performed in 26(30%) patients upon subsequent relapse but the diagnosis remained unaltered in all cases. Rituximab therapy was provided to five and splenectomy was performed in 7 patients. Four patients failed both modalities, all of whom currently are IVIG dependant. Age <5year (OR 0.12, 95%CI 0.22, 0.67, p=0.01) was protective against development of chronic ITP while platelet count >20k at presentation (OR 6.50, 95%CI 1.35, 31.30, p=0.02) and race other than white (OR 36.63, 95%CI 4.61, 291.09, p=0.001) were found to be significantly associated with the development of chronic ITP. Gender, mean platelet volume, total white cell count, and absolute lymphocyte count had no significant association. CONCLUSION: Our study supports the published data that patients with an initial platelet count >20k, older age and non-white race have an increased risk of progression to chronic ITP. Other published variables had no significant association in our analyses. Response to IVIG and WinRho was no different in our patients while rituximab or splenectomy did not lead to a complete resolution in refractory cases. Since bone marrow examination did not alter the diagnosis in any patient, we suggest that routine performance of this procedure may be omitted when a diagnosis of ITP is consistent with clinical history, physical examination and laboratory data. Disclosures: No relevant conflicts of interest to declare.

DIAGNOSIS AND TREATMENT: MANAGEMENT OF IDIOPATHIC THROMBOCYTOPENIC PURPURA

PEDIATRICS ◽  
1964 ◽  
Vol 33 (6) ◽  
pp. 979-980
Author(s):  
Irving Schulman
Keyword(s):  
Idiopathic Thrombocytopenic Purpura ◽  
Systemic Disease ◽  
Purpura Fulminans ◽  
Systemic Infection ◽  
Bone Marrow Examination ◽  
Rational Approach ◽  
Thrombocytopenic Purpura ◽  
Disease States ◽  
History Of ◽  
Acute Itp

THE TERM idiopathic thrombocytopenic purpura (ITP) should be reserved for that hemorrhagic disorder characterized by a subnormal platelet count (usually below 50,000/cu mm) in the presence of a normal marrow containing normal or increased megakaryocytes and the absence of systemic disease capable of inducing thrombopenia. Bone marrow examination is mandatory to rule out leukemia, other infiltrative disorders, and hypoplastic and aplastic states; an L.E. preparation is indicated as are the careful search for systemic infection and renal disease and the detailed inquiry concerning drug ingestion. Although no specific antecedent event can be identified in most cases of ITP, it is recognized that some of the common childhood exanthemata may occasionally be followed by thrombocytopenic purpura (e.g., rubella, rubeola, varicella). The rational approach to treatment must be based upon understanding of the natural history of the disease. Acute ITP has an excellent prognosis and approximately 80% affected children will make a complete and permanent recovery without specific therapy. Of these, three-quarters will recover within 3 months of onset, most within 4 to 6 weeks. Approximately 20% of cases will persist longer than 6 months and are then usually designated as chronic. The mortality rate in acute ITP is extremely low and most of the urgency for treatment stems from concern over central nervous system hemorrhage. It seems clear that the incidence of CNS bleeding is no greater than 2-4% and that in most series reporting a greater incidence cases were not limited to ITP but included instances of thrombotic thrombocytopenic purpura and purpura fulminans, i.e., disease states associated with vasculitis.

scholarly journals EFFECT OF EDUCATIONAL PROGRAM ON NURSES’ PERFORMANCE FOR CHILDREN WITH IDIOPATHIC THROMBOCYTOPENIC PURPURA

2021 ◽  
Vol 13 (2) ◽  
Author(s):  
Sahar Wasfy ◽  
Rahma Soliman ◽  
Ebtisam El-Sayed ◽  
Basma Mahmoud
Keyword(s):  
Idiopathic Thrombocytopenic Purpura ◽  
Educational Program ◽  
Clinical Skills ◽  
Structured Interview ◽  
University Hospital ◽  
Basic Knowledge ◽  
Thrombocytopenic Purpura ◽  
Pediatric Hematology ◽  
Blood Disorder ◽  
Knowledge And Practice

Introduction: Idiopathic Thrombocytopenic Purpura is an autoimmune blood disorder associated with decrease platelets level less than normal, which may result in bleeding occurrence. The actual cause is unknown. It may be progressive if untreated, but may remit spontaneously for several years. The aim of this study was to evaluate the effect of health educational program on nurses’ performance for children with Idiopathic-Thrombocytopenic-Purpura. Methods: The study was Quasi- experimental research design used for 50 nurses working at Pediatric Hematology Unit of Tanta University Hospital and Pediatric Hematology Unit of Al- Mabra Tanta Hospital. Two Tools were used to collect required data: structured interview schedule to collect biosocial data of nurses and observational check list regarding nursing practice. Results: The present study-represented that, three quarter of nurses had poor-knowledge and all of them had unsatisfactory level of practice before the-educational-program-implementation. While immediately and after one month from the implementation of the program the total-scores-of-nurses' knowledge and practice improved. Conclusion: There was a-significant improvement in nursing knowledge and practice in relation to nursing care for children with Idiopathic-Thrombocytopenic-Purpura. Recommendations: In-service-training program should be conducted periodically for nurses' teaching the basic knowledge and clinical skills.

scholarly journals Disseminated Neuroblastoma in an Adult Presenting the Picture of Thrombocytopenic Purpura

Blood ◽  
1956 ◽  
Vol 11 (3) ◽  
pp. 273-278 ◽  
Author(s):  
WILLIAM N. CHRISTENSON ◽  
JOHN E. ULTMANN ◽  
STEVEN C. MOHOS
Keyword(s):  
Bone Marrow ◽  
Acute Leukemia ◽  
Idiopathic Thrombocytopenic Purpura ◽  
Clinical Picture ◽  
Correct Diagnosis ◽  
Blood Picture ◽  
Thrombocytopenic Purpura ◽  
Metastatic Lesions ◽  
Initial Symptoms ◽  
Immature Cells

Abstract A case of neuroblastoma in an adult with extensive metastatic lesions is presented. The initial symptoms and findings suggested idiopathic thrombocytopenic purpura. The blood picture and changes in the clinical picture later led to a diagnosis of acute leukemia. Autopsy disclosed the correct diagnosis, which would have been possible antemortem had the implication of pseudorosette arrangement of immature cells in the bone marrow and the possible occurrence of neuroblastoma in an adult been fully appreciated.

scholarly journals Phospholipid Accumulation in Histiocytes of Splenic Pulp Associated with Thrombocytopenic Purpura

Blood ◽  
1961 ◽  
Vol 18 (1) ◽  
pp. 73-88 ◽  
Author(s):  
SIDNEY L. SALTZSTEIN
Keyword(s):  
Bone Marrow ◽  
Platelet Count ◽  
Idiopathic Thrombocytopenic Purpura ◽  
Lipid Accumulation ◽  
Thrombocytopenic Purpura ◽  
Normal Platelet Count ◽  
Normal Platelet

Abstract Accumulation of a lipid, histochemically a phospholipid, in the histiocytes of the splenic pulp was observed in seven patients with thrombocytopenic purpura. Six had classical idiopathic thrombocytopenic purpura with abundant megakaryocytes in the bone marrow. Splenectomy resulted in clinical and hematologic remissions in four of these six, continued thrombocytopenia in the fifth, and in the continued requirement of corticosteroid to maintain a reasonably normal platelet count in the sixth. The seventh patient, who died shortly after splenectomy, had marked hypoplasia of megakaryocytes. Similar lipid accumulation was not seen in more than 700 other spleens, removed for a variety of reasons, reviewed in this study. Platelet phagocytosis has been suggested as a source of the lipid.

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