Diagnostic value of platelet parameters and megakaryocyte formula of bone marrow in idiopathic thrombocytopenic purpura

The parameters of the megakaryocyte formula and peripheral blood platelet indices were studied in 237 people with diagnoses of idiopathic thrombocytopenic purpura (ITP) and myelodysplastic syndrome (MDS). A correlation analysis was performed between megakaryocyte subpopulations and platelet counts. The threshold values for MPV, PCT and PDW were determined by ROC analysis with the construction of the ROC curve, the calculation of the area under the curve (AUC) and the cutoff threshold. The obtained values make it possible to make a differential diagnosis between ITP and MDS by platelet parameters of peripheral blood without examining the bone marrow.

Clot Waveform Analysis Demonstrates Low Blood Coagulation Ability in Patients with Idiopathic Thrombocytopenic Purpura

Background: Although platelets, which contain large amounts of phospholipids, play an important role in blood coagulation, there is still no routine assay to examine the effects of platelets in blood coagulation. Methods: Hemostatic abnormalities in patients with thrombocytopenia, including those with idiopathic thrombocytopenic purpura (ITP), were examined using clot wave analysis (CWA)–small-amount tissue-factor-induced FIX activation (sTF/FIXa) and thrombin time (TT). Results: Although there were no marked differences in the three parameters of activated partial thromboplastin time (APTT) between normal healthy volunteers and typical patients with ITP, the peak heights of the CWA-sTF/FIXa were markedly low in patients with ITP. The three peak times of the CWA-sTF/FIXa in patients with a platelet count of ≤8.0 × 1010/L were significantly longer than those in patients with a platelet count > 8.0 × 1010/L and the peak heights of the CWA-sTF/FIXa in patients with a platelet count of ≤8.0 × 1010/L were significantly lower than those in patients with >8.0 × 1010/L. The peak heights of the CWA-APTT in patients with ITP were significantly lower than in patients with other types of thrombocytopenia. The three peak heights of the CWA-sTF/FIXa in ITP patients were significantly lower than those in patients with other types of thrombocytopenia. The CWA-TT showed lower peak heights and longer peak times in patients with ITP in comparison to patients with other types of thrombocytopenia. Conclusions: The CWA-sTF/FIXa and CWA-TT results showed that blood coagulation is enhanced by platelets and that the blood coagulation ability in ITP patients was low in comparison to healthy volunteers and patients with other types of thrombocytopenia.

Chronic Myeloid Leukemia in a Patient with Previous Idiopathic Thrombocytopenic Purpura: How to Manage Imatinib Together with Eltrombopag

The occurrence of chronic myeloid leukemia (CML), or other myeloproliferative diseases, after the development of idiopathic thrombocytopenic purpura (ITP) is very rare in the current medical literature. Considering the advances in ITP management, and the wide use of new drugs for ITP and CML, we report an unusual case with this association. Our case report focused on a 64-year-old man with long-standing ITP treated with eltrombopag, who developed hyperleukocytosis during follow-up; after specific laboratory exams, it was diagnosed as CML and he began treatment with imatinib. The treatment with eltrombopag was balanced with imatinib to stabilize his platelet count. Data on bcr-abl and JAK2 transcripts were collected and revealed an optimal response with the achievement of negativization of both molecular signatures. We could demonstrate that treatment with imatinib and eltrombopag was well tolerated and allowed complete molecular remission of CML to be achieved, as well as of ITP.

Construction of Pharmacological Network and Molecular Docking Analysis of Key Molecular Components of Jianpi Yiqi Formula for Idiopathic Thrombocytopenic Purpura

Purpose: To perform network pharmacological analysis so as to identify and screen the active ingredients of Jianpi Yiqi Formula; find its core target and explore its mechanism in the treatment of idiopathic thrombocytopenic purpura (ITP). Materials and Methods: A network pharmacology approach was used to inquire and screen the active ingredients from the Traditional Chinese Medicine System Pharmacology (TCMSP) database for potential active compounds that are commonly contained in the Jianpi Yiqi formula. The Swiss Target Prediction database was used for the prediction of the active ingredient's target of the action; the genecard database was used to search for target genes associated with ITP and to screen for target genes, in which the drug target was intersected with the disease target. Protein interaction network was constructed using string database software for GO and KEGG analysis to construct the "component/target/pathway" pharmacology network of Jianpi Yiqi granules therapy for ITP. Cytoscape 3.7.2 software was harnessed to visualize and integrate this network. The Virtua Drug web-based pharmacology website ( https://www.dockingserver.com ) was used to validate the regulatory relationship between key active compounds and critical pathway molecular signals by molecular docking. Results: Two key active ingredients, quercetin, and kaempferol, were selected from hundreds of herbal ingredients referenced in online pharmacological studies. Molecular docking analysis revealed that quercetin and kaempferol could stably bind PI3K/AKT and exert inhibitory effects, respectively. It was also speculated that PI3K/AKT/mTOR pathway might be the critical pathway for the pharmacokinetic mechanism of Jianpi Yiqi Granules. Conclusion: The present study suggests the multi-component effect characteristic of the treatment of ITP with Jianpi Yiqi granules, thus providing a theoretical basis for the clinical use of Jianpi Yiqi formula.

A Suspected Case of Idiopathic Thrombocytopenic Purpura - A Case Report

Objectives: This study demonstrated the positive effect of herbal medication on a suspected idiopathic thrombocytopenic purpura (ITP) patient-a 57-year-old male with suspected ITP and a decreased platelet count.Methods: The patient was treated with an herbal medicine named Nokyongdaebo-tang, and its effect was measured with periodic platelet blood tests.Results: Before taking the herbal medicine, the patient’s blood platelet count was 98 K/μl, but following treatment, the blood platelet count increased to 201 K/μl and maintained a continuously elevated level.Conclusion: The results indicated that herbal medication may improve the blood platelet count of suspected ITP patients.

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

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.

Manajemen Anestesi pada Seksio Sesarea dengan Idiopathic Thrombocytopenic Purpura: Serial kasus

Trombositopenia merupakan perubahan hemostasis yang umum terjadi pada wanita hamil, namun jarang ditemukan kondisi berat. Idiopathic thrombocytopenic purpura (ITP) merupakan salah satu penyebab trombositopenia pada wanita hamil. ITP ditandai dengan peningkatan penghancuran trombosit oleh antibodi immunoglobulin G (IgG) yang dapat meningkatkan risiko perdarahan pada pasien dan fetus. Kami melaporkan tiga kasus wanita hamil dengan ITP yang akan dilakukan tindakan seksio sesarea. Satu pasien menjalani seksio sesarea emergency dengan trombosit 4000 dan dua pasien menjalani seksio sesarea elektif. Pasien seksio sesarea elektif diberikan transfusi trombosit perioperatif terlebih dahulu. Ketiga pasien menjalani prosedur seksio sesarea dengan teknik anestesi general. Pemantauan perdarahan dilakukan selama sampai dengan setelah operasi. Kondisi postoperatif pasien baik dan dirawat di ruang intensive care unit (ICU). Case Series: Anesthesia Management in Caesarean Section with Idiopathic Thrombocytopenic Purpura Abstract Thrombocytopenia is the most common hemostatic change in pregnancy, but severe thrombocytopenia is rare. One of the causes, idiopathic thrombocytopenic purpura (ITP), is characterized by increased platelet destruction by immunoglobulin G (IgG) antibodies, presenting a high risk of hemorrhage for the patient, but also the fetus, since antibodies may cross the placenta. We report three cases of pregnant women with ITP undergoing cesarean section. One patient underwent emergency cesarean section with a platelet of 4000 and two patients underwent elective cesarean. Patients with elective cesarean section were given the first perioperative platelet transfusion. The cesarean section procedures were performed under general anesthesia. Bleeding monitoring is carried out during up to after surgery.