Common Cause Of Thrombocytopenia Research Articles

Immune or inherited thrombocytopenia? A population-based cohort study on children and adolescents presenting with a low platelet count.

Thrombocytopenia is a common hematologic finding in children and adolescents. Immune thrombocytopenia (ITP) is the most common cause of this finding, but the differential diagnosis includes a growing list of genetic disorders. We aimed to report differences in phenotypes of patients with ITP, inherited platelet disorder (IPD)/primary immunodeficiency disorder (PID), and other causes, with a focus on differentiating ITP from inherited thrombocytopenia. This retrospective, population-based observational cohort from 2006 to 2020 involved 506 Finnish children under 16years of age presenting with isolated thrombocytopenia. Of the 506 participants, 79.7% had ITP, 6.7% had IPD/PID, and 13.6% had other causes of thrombocytopenia. A platelet count of ≤12 × 109/L best distinguished between ITP and other reasons with a sensitivity of 60% and a specificity of 80%. Among patients with the lowest platelet count of less than 10 × 109/L, 95.9% had ITP, 3.3% had IPD/PID, and 0.8% had other causes. Severe bleeding events were reported in 20 patients (4.0%), but there were no cases of intracranial or fatal bleeding due to thrombocytopenia. Up to 50% of patients with a high suspicion of inherited thrombocytopenia remained without a specific diagnosis despite genetic testing. ITP remains the most common cause of thrombocytopenia. A platelet count of ≤12 × 109/L often leads to an ITP diagnosis. Genetic disorders are rare but should be suspected in patients with persisting thrombocytopenia, especially with platelet counts constantly above 12 × 109/L, a positive family history, or atypical clinical features.

To determine the various causes of thrombocytopenia and its clinical correlation with bleeding in children and adolescents

Thrombocytopenia refers to a reduction in platelet count below 1,50,000/cumm. It is the most common cause of defective primary hemostasis that can lead to significant bleeding in children. It was a retrospective observational study conducted in a tertiary care hospital in Bhilai, chattisgarh between Augusts to December 2021. Data collection was done from Sept 2018-Sept 2019. The aim of present study was to determine the various causes of thrombocytopenia in children and adolescents and to correlate its severity with etiology and risk of bleeding. Total 112 patients were included from age group 1y-18 yrs. Out of total 112 patients 59 were males and 53 were females. 27 patients were 1-5 years of age, 30 patients were 6-12 years of age and55 were 13-18 years. The mean platelet count in my study was 68,340/cumm with a minimum of 4000/cumm. Bleeding was present in total 19 (16.9%) patients. The main bleeding manifestations were petechie or purpurae, epistaxis, ecchymosis, gastrointestinal bleed and others. Severity of thrombocytopenia correlates significantly with risk of bleeding (The p-value is 0.001**). The most common cause of thrombocytopenia in 69 patients with fever were infective and 43 patients without fever it was vitamin b12 deficiency. Severity of thrombocytopenia (p=0.0528) and bleeding (p=0.121) in patients with fever and without fever was not significant. Thrombocytopenia in pediatric and adolescent children is caused by both infective and non infective illness. It mainly presents with cutaneous bleeds and mucosal bleeds. Severity of thrombocytopenia is significantly correlated with bleeding.

Prednisone Plus Ivig Compared with Prednisone for Immune Thrombocytopenia during Pregnancy

Introduction Immune thrombocytopenia (ITP) is an acquired autoimmune disease characterized by an isolated low platelet count and is the most common cause of thrombocytopenia during pregnancy, accounting for 1%-4% of thrombocytopenia in pregnant women. Women with ITP who have severe thrombocytopenia are at an increased risk for life-threatening obstetric complications. However, management of ITP during pregnancy can be challenging because treatment choices are limited. Corticosteroids or intravenous immunoglobulin (IVIg) are recommended as first-line treatments for pregnant women with ITP, but the response to initial treatment is approximately 39% and 38%, respectively, lower than that in nonpregnant patients with ITP. Therefore, in-depth studies investigating new solutions for the first-line treatment of ITP during pregnancy are urgently needed. Our previous retrospective study revealed an advantage of prednisone combined with IVIg compared to prednisone monotherapy for pregnant patients with ITP. Therefore, the aim of this prospective, randomized, open-label study was to further assess the efficacy and safety of prednisone plus IVIg compared to prednisone monotherapy in pregnant women with ITP. The study has been registered at clinicaltrials.gov. NCT05333744 Methods Eligible treatment-naive ITP patients during pregnancy with a platelet count < 30 × 10^9/L, accompanied by or without bleeding symptoms, were randomly assigned 1:1 to receive prednisone 20 mg per day for 4 weeks plus IVIg 400 mg/kg (total dose ≤20 g per day) for 5 days or prednisone 20 mg monotherapy per day for 4 weeks. Prednisone was gradually tapered to the maintenance dose of 5-10 mg per day until 6 weeks after delivery if there was a response to treatment; otherwise, prednisone was gradually tapered to withdrawal. The primary outcome was overall response (OR), defined as a platelet count ≥ 30 × 10^9/L, a doubling of the baseline platelet count and the absence of bleeding. Secondary endpoints included complete response (CR), time to response, platelet counts at delivery, platelet counts of newborns, and adverse events in parturients. CR was defined as platelet count ≥100×10^9/L measured on 2 occasions at least 7 days apart and the absence of bleeding. Results A total of 100 treatment-naive ITP patients during pregnancy were randomly assigned to either the prednisone plus IVIg (n=50) or prednisone monotherapy (n=50) groups. All the baseline characteristics were comparable between the two groups. The median ages of patients in the prednisone plus IVIg group and prednisone monotherapy group were 30.32 years (range, 22-43) and 30 years (range, 28-46), respectively. For patients in the combination and monotherapy groups, the mean estational ages at intervention start were 28.3 weeks and 30.9 weeks, respectively. All patients were followed up for more than 2 months. OR was observed in 23 (46.0%) patients in the combination group and 22 (44%) in the monotherapy group, and no significant difference was observed between the two groups (p=0.91). A significant difference was observed in the time to response between the prednisone plus IVIg group and prednisone monotherapy group (6.14 days vs. 9.84 days, p=0.001). However, the predelivery platelet transfusion of the prednisone plus IVIg group was greater than that of the prednisone monotherapy group. There were no significant differences in the delivery mode between the combined group and monotherapy group. No significant differences were found between the two groups in neonatal outcomes, particularly concerning the neonatal platelet counts. Conclusion Prednisone plus IVIg was an effective and safe treatment for ITP in pregnancy, and this therapy may be a new first-line treatment option for pregnant patients with ITP.

Hematologic Response to Steroid Use in Patients with Primary Immune Thrombocytopenia: A Research Study in a Salvadoran Population

Introduction. Thrombocytopenia Immune (ITP) is an acquired thrombocytopenia caused by autoantibodies against platelet antigens. It is one of the more common causes of thrombocytopenia in otherwise asymptomatic adults. The use of high-doses dexamethasone has proven efficacy and safety in previously untreated patients with immune thrombocytopenia even though these findings are not entirely clear yet. AIM. The primary goal to assess the global response (platelets >30 x 109/L) and complete response (platelets >100 x 109/L) within the different implemented regimes in previously untreated adult with primary immune thrombocytopenia. Further goals aimed to describe the clinical characteristic of patients with primary immune thrombocytopenia and the most frequent adverse events in the use of steroids. Results. A total of 44 patients were treated with steroids, 16 patients in the high-dose dexamethasone (HD-DXM) group, 23 patients received methylprednisolone (MTP) and 5 patients with prednisone (PDN). The female gender was the most affected in all the groups with 61.3% (n=27) presenting more cases than the female sex in the methylprednisolone group 65.2% (n=15), although without significant statistical difference (P = 0.384). The mean age of onset was 38, 44, and 40 years, respectively (P = 0.352). The most frequent clinical manifestations were purpura sicca (petechiae and bruising) with 75%, 91.3% and 60.0%, for the dexamethasone, methylprednisolone and prednisone groups, respectively. The mean platelet count in the groups was around the mean of 26 x 109/L, with the methylprednisolone group presenting the lowest values (3 x 109/L). The overall response was different for the three groups (87.5% vs 95.6% vs 100%, P = 0.43) with a complete response of 56.2% vs 60.8% vs 80.0% (P = 0.85). Early response was achieved in the methylprednisolone group with 3.5 days, versus dexamethasone with 4.0 days and prednisone with 7 days. The sustained response at 6 months was lower in the prednisone group 80.0%. The most frequent adverse events occurred in the HD-DXM group with fatigue in 31.2% (n = 5) followed by edema, hyperglycemia and insomnia with 18.7% (n = 3). Conclusions. Our study demonstrated that PDN provides greater overall responses as initial treatment in ITP. MTP provides the fastest responses followed by HD-DXM. The sustained response was maintained in the HD-DXM Group. The HD-DXM group presented 68.7% cases with at least one adverse event associated with the use of the steroid. The findings suggest continuing to perform more studies in our population.

Maternal and Neonatal Outcomes of Gestational Thrombocytopenia in Pregnant Women from Kirkuk City, Iraq: A Case-Control Study

Background: Thrombocytopenia is the most common hematological disorder in pregnant women, second only to anemia. A platelet count of less than 150x109/L is regarded as low. It is the most common cause of thrombocytopenia during pregnancy when the platelet count does not fall below 70x109\L. Methods: A case-control study was carried out in the department of obstetrics and gynecology at Azadi Teaching Hospital, Kirkuk, Iraq. Two hundred pregnant women were enrolled in the study; they were divided into 100 cases and 100 controls. All participants were in labor at the time of admission. The cases were pregnant women with gestational thrombocytopenia, while the controls were pregnant women with a normal platelet count. A platelet count was performed for all participants using the Swelab Alfa Plus system. Results: mean gestational age and platelet count were significantly lower in patients than controls, while there was no statistically significant difference in age or parity between the study groups. Preterm labor, postpartum hemorrhage (PPH), intrauterine fetal growth restriction (IUGR), and intrapartum fetal distress were significantly higher in the patients than in the controls, and the mean APGAR score at 5 minutes was significantly lower in the patients compared to the controls. Conclusions: Pregnant women with gestational thrombocytopenia may be at higher risk of preterm labor, postpartum hemorrhage, IUGR, intrapartum fetal distress and a low neonatal APGAR score.

The Combination of Intravenous Immunoglobulin (IVIG) and Low Does Recombinant Human Thrombopoietin (rhTPO) for the Management of Corticosteroid/IVIG Monotherapy-Resistant Immune Thrombocytopenia in Pregnancy

Introduction Primary immune thrombocytopenia (ITP) is a common autoimmune disease characterized by a low platelet count resulting from antibody-mediated platelet destruction and insufficient platelet production. ITP, with a prevalence of 1 in 1000-10 000 pregnancies, accounts for approximately 3% of all causes of thrombocytopenia in pregnancy and is reported to be the most common cause of thrombocytopenia in the first and early second trimesters. It has been revealed that severe ITP is associated with devastating outcomes. It remains a challenge to manage pregnant patients with ITP. First-line treatment options in pregnant ITP patients currently include corticosteroids and intravenous immunoglobulin (IVIg). However, previous studies reported that the response rate of pregnant ITP patients to corticosteroids was less than 40% and that to IVIg was 38-56%, which was lower than that of nonpregnant ITP patients. The second-line treatment options are limited for pregnant ITP patients. Recombinant human thrombopoietin (rhTPO), a full-length and glycosylated TPO with a molecular weight of 90 000 Daltons developed by 3SBIO (Shenyang, China), has also been approved by the China State Food and Drug Administration as a second-line option for nonpregnant ITP patients. It cannot cross the placenta theoretically with such a large molecular weight, and thus, it has an apparent theoretical advantage over the two TPO mimetics since it would not impact the fetus. A study investigating the application of rhTPO in pregnancy suggested that rhTPO was a potentially effective and well-tolerated treatment option for ITP patients during pregnancy. It might be explained that the development of ITP was associated with increased platelet destruction and impaired platelet production, and the combination of IVIg and TPO mimetics impacts these two targets since IVIg could reduce platelet destruction, whereas TPO mimetics could increase platelet production. Therefore, we conducted a monocenter, single-arm, open-label study to investigate the efficacy and safety of low-dose rhTPO plus IVIg in pregnant corticosteroid/IVIg monotherapy-resistant ITP patients. Methods This study was registered at www.clinicaltrials.gov as NCT05634824.The following criteria were considered: patients have a diagnosis of primary ITP before or first onset during pregnancy; patients ≥ 18 years; patients complicated with bleeding manifestations and/or have a platelet count < 30 × 10^9/L and failed to respond to initial treatment of corticosteroids or intravenous immunoglobulin (IVIg) monotherapy or relapsed during the tapering or discontinuation of corticosteroids. For those patients, the initial combination therapy consisted of rhTPO at an initial dose of 150 U/kg once daily subcutaneously for 28 days and IVIg 400 mg/kg per day for 5 days. If the platelet count was in the range of 30 to 50 × 10^9/L, the combination therapy was repeated. To reduce the risk for thrombocytosis, patients received maintenance therapy consisting of rhTPO at a dose of 150 U/kg per day if the platelet count rose above 50 × 10^9/L, and treatment was discontinued when platelet counts exceeded 100 × 10^9/L. After delivery, the treatment consisted of rhTPO 150 U/kg per day, and the dose was maintained if the platelet count exceeded 30 × 10^9/L. In addition, IVIg 400 mg/kg per day for 5 days was added if the platelet count could not be maintained above 30 × 10^9/L. If patients did not achieve a count of 30 × 10^9/L within 4 weeks, treatment was also discontinued. Results The study included 19 patients with thrombocytopenia during pregnancy who were admitted to Peking University People's Hospital from December 1, 2022, to May 30, 2023, all of whom had failed hormone and IVIG treatment. The median age of those patients was 34 years old (range 20 to 42 years old), and the median platelet count before treatment was 13×10^9/L (range 1-30×10^9/L). The four-week response rate was 63.2% (12/19), and the median response time was 7.5 days (range 5 to 35 days). There were no treatment-related adverse reactions. Conclusions Low-dose rhTPO plus IVIg in pregnant corticosteroid/IVIg monotherapy-resistant ITP patients is effective and safe. These findings suggest that IVIg plus low-dose rhTPO may represent a potential combination therapy for pregnant patients with ITP.

Study of the Aetiology and Clinical Manifestations of Thrombocytopenia in a Tertiary Care Centre.

Introduction Thrombocytopenia is a commonly observed condition in clinical practice, and its diagnosis is often challenging due to numerous aetiologies and variations in clinical presentation. Early identification of thrombocytopenia and its causes can help prevent life-threatening haemorrhagic manifestations. Methodology A prospective observational study was conducted at a tertiary care hospital from February 2019 to January 2020. This evaluation aimed to determine the causes and prevalence of thrombocytopenia in a tertiary care setting. Patients aged 15 or older with a platelet count of fewer than 150,000/ µL were eligible for inclusion in this evaluation. Investigations for aetiology detection were recommended. Results During the one-year study period, a total of 100 patients, including 58 males and 42 females, with thrombocytopenia were selected for the study. The most common age group affected by thrombocytopenia in this study was between 46 and 55 years old. The most common clinical manifestations observed were generalised weakness (70%), haemorrhagic manifestations (60%), fever (50%), joint pain (37%), splenomegaly (35%), headache (30%), breathlessness (23%), lymphadenopathy (22%), hepatomegaly (24%), and abdominal pain (12%). The most prevalent causes of thrombocytopenia were megaloblastic anaemia (19 cases), dengue fever (15 cases), malaria (11 cases), enteric fever (nine cases), immune thrombocytopenia (ITP) (eight cases), and leukaemia (seven cases). Bleeding was reported as a symptom of thrombocytopenia in 60% of individuals in this study. Conclusion In the study, thrombocytopenia was more common in people aged 46-55 years, and males were more commonly affected than females. Megaloblastic anaemia and infectious disease were the most common causes of thrombocytopenia. Bleeding manifestations were found in 60% of patients with thrombocytopenia.

Випадок тяжкої імунної тромбоцитопенії під час вагітності

Immune thrombocytopenia (ITP) is one of the most common causes of thrombocytopenia (TP) in pregnancy and is the main cause of severe TP among pregnant women. Autoimmune pathogenesis determines the danger of hemorrhagic complications both for the pregnant and for the fetus and newborn. Differential diagnosis between gestational and immune thrombocytopenia is necessary, as this determines further tactics. The goal of ITP treatment is to achieve a safe level of platelets according to the gestational age and clinical situation. For treatment, different lines of therapy are used alternately with step-by-step control of effectiveness. Purpose - to analyze the worldwide and personal experience of pregnancy management in severe ITP refractory to treatment. We present a case of pregnancy management and delivery with a severe immune thrombocytopenia, diagnosed at 25 weeks of pregnancy with hemorrhagic syndrome, unresponsive to treatment. All pharmacological tools were used. Delivery by caesarean section with appropriate preoperative and intraoperative transfusion preparation. Recombinant human thrombopoietin was used in the postoperative period. The newborn has thrombocytopenia without hemorrhagic syndrome. Conclusions. Correct diagnosis of conditions accompanied by thrombocytopenia during pregnancy determines the correct and effective treatment tactics. Pregnancy and childbirth in women with severe thrombocytopenia belong to the group of extremely high risk. Antenatal management and delivery of such pregnant women should be carried out by a multidisciplinary team with the participation of a hematologist, a specialist in internal medicine, under careful control of laboratory indicators and clinical changes, with control of the fetal antenatal condition. It is necessary to control the platelet level of the newborn in the postnatal period. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Fever with Thrombocytopenia in the Pediatric Age Group

Introduction: Fever with thrombocytopenia refers to a reduction in platelet count below 150,000/L in association with fever. Although febrile thrombocytopenia may occur due to aplastic anemia, malignancy or megaloblastic anemia, its commonest cause in the pediatric age group is infections like Dengue fever, Malaria and Enteric fever. Since infectious diseases are highly prevalent in our region we decided to determine the frequency of diseases associated with febrile thrombocytopenia in the pediatric age group. Objective: To determine the frequency of diseases associated with febrile thrombocytopenia in the pediatrics age group Study Design: Descriptive Cross-Sectional Study Place and Duration: Department of Paediatric Medicine, Civil Hospital, Karachi, Pakistan from November 22, 2018, to May 21, 2019 Methodology: After obtaining informed consent data related to signs, symptoms, clinical and confirmed diagnosis, and relevant lab results were recorded for children who fulfilled the inclusion criteria. Data were analyzed in terms of frequencies and percentages for qualitative variables like age group, gender and outcome variables. Results: Mean ± SD of age was 4.74±3.28. Out of 89 patients, 45(50.56%) were male and 44(49.44%) were female. In distribution for common causes of thrombocytopenia, 19 (21.3%) had malaria, 8 (9%) had dengue, 25 (28.1%) had an enteric fever, 32 (36%) had sepsis, 2 (2.2%) had malignancy and 3 (3.4%) had megaloblastic anemia. Conclusion: Sepsis, dengue, and malaria were the most frequent causes of thrombocytopenia. Therefore, anytime thrombocytopenia is found, more investigations can usually assist us in making the right diagnosis. Keywords: Febrile Thrombocytopenia, Malaria, Sepsis, Dengue, Enteric.

Omicron-Induced Immune Thrombocytopenia: A Case Report

Coronavirus disease 2019 is a systemic infection that significantly impacts the hematopoietic system and hemostasis. Among the hematological manifestations described, severe and symptomatic thrombocytopenia is rare. Immune thrombocytopenia (ITP), also known as idiopathic thrombocytopenic purpura or immune thrombocytopenic purpura, is an acquired thrombocytopenia caused by autoantibodies against platelet antigens. It is one of the more common causes of thrombocytopenia in otherwise asymptomatic adults. Here, we report the case of a patient who developed ITP after a severe acute respiratory syndrome coronavirus 2 infection to highlight the rarer hematological manifestations of the disease and the changes in treatment.

Thrombocytopenia and Retina

Platelets play a role in blood coagulation and wound healing. Thrombocytopenia is defined as a platelet count of less than 150000/mm3 in the peripheral blood. The most common cause of thrombocytopenia is increased destruction. Ocular involvement is rare in thrombocytopenia, and bleeding is the most common complication. The increased tendency to thrombosis observed in some types of thrombocytopenia causes occlusion in retinal arterioles, and this results in retinal ischemia. Combined systemic and ocular interventions are used in the treatment.

A rare combination of immune thrombocytopenia and disaggregation thrombocytopathy: course and termination of pregnancy complicated by COVID-19 (Clinical case)

Immune thrombocytopenia (ITP) is an autoimmune disease which is characterized by antibody-mediated destruction of platelets by the reticuloendothelial system. The rate of ITP is 3.3 per 100,000 adults per year with a prevalence of 9.5 per 100,000 adults. Pregnancy does not increase the frequency or severity of ITP, but ITP can significantly affect pregnancy and cause bleeding in women.Pregnancy requires regular control of the number of platelets: monthly in the I and II trimesters, every 2 weeks – in the III trimester, and weekly control near the delivery date. Indications for treatment are determined by the pregnant woman condition, not the fetus, since it has not been proven that the treatment reduces the risks of thrombocytopenia in newborns with the development of cerebral hemorrhage.The drug of the first line of treatment of such pathology is prednisolone at a dose of 1 mg/kg orally once a day. An increase in the number of platelets is usually observed within 3-7 days, the maximum response is determined after 2-3 weeks. If necessary, the dose can be increased. When the required level of platelets is reached, the dose can be gradually reduced by 10-20 % to the minimum dose necessary to maintain the number of platelets at an acceptable level.Thrombocytopathy can be the cause of primary hemostasis disorders, even if the number of platelets in the blood is normal. For diagnosis, tests are carried out to detect the aggregation ability of platelets. In addition, flow cytometry can be used, which makes it possible to detect the defects of surface membrane receptors, as well as defects of the end point of secretion.ITP is a common cause of thrombocytopenia after viral infections. The onset of this pathology is more often detected in the second and third weeks after the onset of COVID-19. The treatment aim is to prevent the significant bleeding in patients with COVID-19.The article presents a clinical case of a pregnant woman with ITP and thrombocytopathy, whose pregnancy was complicated by COVID-19. The patient complained on bleeding gums, the appearance of hematomas on the skin. Medical treatment of the main disease included prednisolone, eltrombopag, intravenous human immunoglobulin, transfusion of platelet concentrate. At 34–35 weeks of pregnancy alive boy was born with a body weight of 2800 g, length of 49 cm, 7–8 points on the Apgar scale.

Immature Platelet Fraction as a Predictor of Recovery of Platelets in Febrile Thrombocytopenia Patients

Abstract Introduction: Infection is the most common cause of thrombocytopenia. Thrombocytopenia is a common hematological abnormality in infections such as viral (dengue), malaria, rickettsial infections, and leptospirosis which demands platelet transfusion in many severe cases. Although platelet transfusion is lifesaving, it has its own hazards. Hence, we used new parameters such as immature platelet fraction (IPF), which is a measure of reticulated platelets that reflects the rate of thrombopoiesis. This study was performed to assess the role of IPF in predicting platelet recovery in febrile thrombocytopenia patients. Materials and Methods: Blood samples from 50 patients were collected for IPF on day 2 of admission with 5 days of platelet count (day 1 through day 5 of admission). IPF is analyzed by Sysmex XE-2100 hematology analyzer in the platelet channel with fluorescent dye and carefully designed gating system and counted with a special software IPF master 7. IPF values against platelet count were assessed separately from day 1 to day 5. Results: The reference intervals of IPF >8% and IPF <8% were assessed against platelet count. An increase in IPF favored an increase in platelet count on day 4 and day 5. It was found that IPF has a strong correlation with the recovery of platelet counts. In patients with febrile thrombocytopenia, 82.4% of patients showed recovery within 24 h after attaining the peak IPF. One hundred percent of patients showed recovery within 24–48 h of the rise of the IPF. Conclusion: A rapid and inexpensive automated measurement of IPF can be integrated as a standard parameter to evaluate the thrombopoietic state of the bone marrow. From the study, we concluded that IPF is an important predictor of increase in platelet count. Increase in IPF >8% suggests that platelet count will be increased in the next 48 h indicating that further platelet transfusion will not be required.

Clinical Presentations of Idiopathic Thrombocytopenic Purpura

Back Ground: ITP is the most common cause of thrombocytopenia in children and is a result of immunologically mediated increased platelet destruction, which is usually acute and self-limiting but may be a recurrent or chronic disorder. Aim of Study: Assessment of clinical manifestation of ITP in children. Patient and Methods: A prospective study was performed on 60 patients diagnosed as idiopathic thrombocytopenic purpura admitted to central child teaching hospital from 1st of January to 3o September 2011. Diagnosis was based on clinical and laboratory tests including bone marrow aspiration. Results: The age ranged from 6 months to 13 years and majority of cases were between 1-5 years, 68.3 % were males and 31.7 % were females, male to female ratio 2.1 : 1 . History of upper respiratory tract infection preceded the onset of illness in 71.7 % of patients. Where the Duration between Preceding URTI and ITP Up to 1 week in 30.2 % and > 1 week in 79.8 % Concerning the distribution of cases according to the season of the year: One case (1.7%) found during January, four cases (6.7%) during February, six cases (10.0%) during March, five cases (8.3%) during April, ten cases (16.7%) during May, eight cases (13.3%) during June, 14 cases (23.3%) during July , five cases (8.3%) during August, and seven cases (11. 7%) during September. This distribution was significant (P less than 0.05). The commonest presentation was cutaneous bleeding in 60 %, Mucous Membrane bleeding 1.7 %, both 38.3 % , Splenomegaly with bleeding 6.7 % , Hepatomegaly with bleeding 8.3 %, Lymphadeno-pathy with bleeding 5 % . In 69 % of cases the initial platelet count was less than 20.000 /mm³. 37.9 % had anemia. Bone marrow examination done in 56 case and all were normal. In this study, one case die due to intracranial hemo – rrhage . we didn’t include the management because the patients receive different types of treatments ( mostly by steroid , some by IVIG and anti-D ) , most of patients examined by bone marrow aspiration which was normal , and also we didn’t include the follow up because of most of the patients didn’t come for follow up. Conclusion: The disease is self-limited , most cases at age of 1-5 years , male affected more than female , most cases preceded by upper respiratory tract infections , most cases presented by skin bleeding.

Study of thrombocytopenia in patients of acute febrile illness

Introduction: Many viral and bacterial infections result in thrombocytopenia and are most common non-iatrogenic cause of thrombocytopenia. Infections can affect both platelet production and platelet survival. In addition, immune mechanisms can also be a cause, as in immune-mediated thrombocytopenia (ITP) in children following viral infection. In our setup, tropical infections like malaria, dengue and leptospirosis formed the most common and important causes of thrombocytopenia. Objectives: To correlate the bleeding manifestations of thrombocytopenia with platelet count in patients with acute febrile illness and to document the incidence of thrombocytopenia and most common cause of thrombocytopenia among patients with acute febrile illnesses. Methodology: A minimum of 200 patients admitted to tertiary care center with documented fever of >37.50C and platelet count <1,50,000/µL were selected using purposive sampling techniques. They were followed from admission till recovery, discharge or death. Correlation of bleeding manifestations like petechiae, gum bleeding, hematuria, menorrhagia, epistaxis in relation with lowest platelet count was done along with categorization of patients according to different platelet count ranges. Results: Out of total 200 patients 65% were male and 35% were female.

Management of Immune Thrombocytopenic Patient Associated with COVID-19 Viral Infection: A Case Series

Severe thrombocytopenia is a cause of morbidity and mortality for patients with COVID-19 infection. The common causes of thrombocytopenia in these patients are; sepsis, drug-associated, disseminated intravascular coagulation (DIC), heparin-associated thrombocytopenia (HIT), microangiopathic hemolytic anemia (MAHA). Recently, cases of COVID-19 infection-associated Immune thrombocytopenic purpura (ITP) have been reported in the literature. In our study, we will present our case series consisting of 10 patients associated with COVID-19

Thrombocytopenia in Pregnancy: Identification and Management at a Reference Center in Pakistan.

Objective: The study aimed to evaluate the causes of thrombocytopenia in pregnancy and its management along with the outcome in the COVID-19 era.Methods: Recruitment for this prospective, cross-sectional observational study of thrombocytopenia in pregnancy (platelet counts <100x109/L) was done from January 2017 to August 2020 at the National Institute of Blood Diseases (NIBD) after taking the patients’ informed consent. Complete clinical and lab profile of patients was also collected.Results: A total of 150 pregnant women with thrombocytopenia were enrolled, with the mean age being 27.3±4.64 years. Mean platelet counts at baseline were 48.0±24. Main clinical manifestations at baseline included: anemia 65.9%, bruises 23.25%, and edema 9.3%. Causes of thrombocytopenia were gestational thrombocytopenia (GT) 72 (48%), acute fatty liver five (3.3%), pre-eclampsia in 11 (7.3%), and eclampsia seven (4.6%). Causes not specific to pregnancy included 30 (20%) cases of ITP, hepatitis C, and nutritional deficiency was reported in nine (6%) patients each. 72/150 received supportive care treatment to manage thrombocytopenia and were closely monitored and given supplements. Twenty (66.6%) ITP patients received treatment with steroids, with complete response in 70% of them seen. Overall, 38 (25.3%) women with bleeding symptoms and platelet count <50x109/L received platelet transfusions.Conclusion: The study shows that pre-eclampsia and eclampsia are serious conditions with a high risk for complications, while GT is a benign and the most common cause of thrombocytopenia in pregnancy which requires no active treatment. The other causes such as ITP and infections require individualized management.

Refractory thrombocytopenia could be a rare initial presentation of Noonan syndrome in newborn infants: a case report and literature review

BackgroundNoonan syndrome (NS) is a relatively rare inherited disease. Typical clinical presentation is important for the diagnosis of NS. But the initial presentation of NS could be significant variant individually which results in the difficult of working diagnosis. Here we report a rare neonatal case of NS who presented with refractory thrombocytopenia as the initial manifestation.Case presentationThis was a preterm infant with refractory thrombocytopenia of unknown origin transferred from obstetric hospital at 6 weeks of age. During hospitalization, typical phenotypes of NS in addition to thrombocytopenia were observed, such as typical facial characteristics, short stature, atrial septal defect, cryptochidism, coagulation defect and chylothorax. Genetic testing showed a pathogenic variant at exon 2 of the PTPN11 gene with c.124A > G (p.T42A). Respiratory distress was deteriorated with progressive chylothorax. Chest tube was inserted for continuous draining. Chemical pleurodesis with erythromycin was tried twice, but barely effective. Finally, parents decided to withdraw medical care and the patient died.ConclusionsThrombocytopenia could be the first symptom of Noonan syndrome. After ruling out other common causes of thrombocytopenia, NS should be considered as the working diagnosis.

2021 Chinese consensus on the diagnosis and management of primary immune thrombocytopenia in pregnancy.

2021 Chinese consensus on the diagnosis and management of primary immune thrombocytopenia in pregnancy.

A Study of Maternal and Fetal Outcome of Thrombocytopenia in Pregnancy

Background: Thrombocytopenia is found to complicate pregnancies in India. The major function of platelets is the initiation of haemostasis. Thrombocytopenia can result in spontaneous bleeding from any part of the body. It may be associated with serious bleeding at delivery and may require emergent maternal and neonatal care. Introduction: After anaemia, thrombocytopenia is the most frequently occurring hematologic disorder in pregnancy. It is found to complicate 7% to 8% of pregnancies in India. The major function of platelets is the initiation of haemostasis, and hence, thrombocytopenia can result in spontaneous bleeding from any part of the body. It may be associated with serious bleeding at delivery and may require emergent maternal and neonatal care. Thrombocytopenia is diagnosed if the platelet count 150 × 109/l, caused by increased platelet lysis or reduced inefficient production. Aims &amp; Objectives: To study the maternal and fetal outcome of thrombocytopenia in pregnancy and to study some of the causes of thrombocytopenia in pregnancy. Methodology: Total 113 cases with maternal thrombocytopenia were included in present study after satisfying inclusion and exclusion criteria and followed till delivery. We studied maternal complications gestational age at delivery, indication of induction of labour and method (if required) and mode of delivery, NICU stay were recorded. Results: Majority of the patients i.e. 63 patients (55.8%) were in the age group of 20-25 years. Among 113 cases; primigravida (56 cases, 49.6%) and multigravida (57 cases, 50.4%) were almost equally distributed. Majority of the study population was diagnosed with Gestational thrombocytopenia 50.4% followed by severe pre-eclampsia 22.12%, HELLP syndrome 8.8%, abruption 5.3% antepartum eclampsia and dengue 2.7% each. Maternal mortality was seen in 2 cases (1.8%). Mean birth weight was found to be 2.45 Kgs. of 113 babies, neonatal mortality was seen in 15 cases, NICU admission was indicated in 18 babies and KMC care was needed for 1 baby. Conclusion: The most common cause of thrombocytopenia during pregnancy is Gestational Thrombocytopenia (GT) followed by pre-eclampsia, eclampsia and HELLP syndrome. With platelet counts above 70,000/ μLno prior history of thrombocytopenia the condition is more likely to be GT. The lack of well-defined symptomatology and clinical presentation makes early and accurate diagnosis difficult leading to delay in treatment.