Common Cause Of Thrombocytopenia Research Articles

A Clinical Study of the Association of Thrombocytopenia with Acute Febrile Illness

Abstract Background: Thrombocytopenia accompanying acute febrile illnesses is a matter of concern because lack of prompt treatment could result in significant mortality. We in this study tried to evaluate the clinical profile of cases with acute fever and thrombocytopenia and determine the cause of fever with thrombocytopenia and the outcome of treatment of such patients in our hospital. Methods: A total of n=50 successive cases of acute febrile illness with thrombocytopenia following inclusion and exclusion criteria were included in this study. Clinical signs such as rashes, signs of dehydration, petechiae, jaundice, lymphadenopathy, hepatomegaly, splenomegaly, anemia, abdominal tenderness, altered sensorium, were noted. Investigations included CBP, ESR, LFT, RFT, serum electrolytes, Chest X-ray, USG abdomen were done. Other investigations included Dengue serology, Malaria, Widal, IgM for leptospirosis, sputum for AFB. Results: Out of n=50 patients with acute fever with thrombocytopenia, all of them had a definitive diagnosis with malaria (40%) as the commonest cause, followed by enteric fever (24%), viral fever (14%), septicemia (6%), dengue (14%), and leptospirosis (2%). 50% of the patients had platelet count in the range of 50, 000 – 1,00, 000 and 30% had platelet counts above 100000-150000. 8% of cases had platelet counts below 25000 and 12% had platelet counts between 25000-50000 at the time of admission. 10% mortality was observed. Conclusion: infections as the commonest cause of thrombocytopenia. Malaria, dengue enteric fever, leptospirosis, and other viral infections formed the major diseases in this group of population. The diagnosis of malaria was the common cause because of seasonal and regional variations. A definitive increase in platelet count was noted after the underlying cause was treated. Severe cases of septicemia with associated co-morbidities resulted in mortality.

Fetomaternal outcome in pregnancy with thrombocytopenia: A prospective study from one of the teaching health-care institutes of Ahmedabad, Gujarat

Background: During pregnancy, hemodilution of plasma volume leads to reduction in platelets count by approximately 6–7% during 3rd trimester. Pregnant women with thrombocytopenia have higher risk of bleeding excessively during pregnancy, labor, and puerperium. The present study focuses on fetomaternal outcome among pregnant women having thrombocytopenia. Aims and Objectives: This study aims to study the incidence of thrombocytopenia in pregnancy, to identify various factors responsible for thrombocytopenia in pregnancy, and to evaluate fetomaternal outcome in patients with thrombocytopenia in pregnancy. Materials and Methods: A prospective study was conducted in the department of obstetrics and gynecology at tertiary care center of Ahmedabad. A total of 96 cases of thrombocytopenia in pregnancy were included in the study. Fetomaternal outcome was assessed among the study participants. Results: The incidence of thrombocytopenia in the present study was 0.77%. Obstetric causes (53.12%) accounted for most common cause of thrombocytopenia, followed by gestational thrombocytopenia (27.08%), dengue (10.41%), malaria (4.16%), and immune thrombocytopenia (4.16%). Postpartum hemorrhage (15.62%), eclampsia (14.58%), disseminated intravascular coagulation (11.45%), and abruption (8.33%) were the most common maternal complications. The most common neonatal complication was prematurity (67.7%) followed by intrauterine growth retardation (23.95%) and birth asphyxia (9.3%). Conclusion: Hypertensive disorders of pregnancy including severe preeclampsia, eclampsia, and HELLP syndrome are found to be the most common cause of thrombocytopenia followed by gestational thrombocytopenia and infectious causes. The present study widened the spectrum of the causes for thrombocytopenia in pregnant women. Gestational thrombocytopenia is associated with mild-to-moderate thrombocytopenia and hardly having any complications.

An evaluation of thrombocytopenia cases in the hematology clinic of the Ankara Numune Training and Research Hospital

Background Thrombocytopenia is a major disease that requires the referral of outpatient and hospitalized patients to hematology specialists. Objectives The present study aims to evaluate the laboratory and transfusion statuses of adult patients admitted to our hospital and receiving outpatient/inpatient treatment and diagnosed with thrombocytopenia (<100 × 109/l). Design Single-center, retrospective, laboratory-based study. Patients and methods In the study, after obtaining permission of the hospital's Non-Invasive Clinical Research Ethics Committee, the information of patients diagnosed with thrombocytopenia (platelet count <100 × 109/l) and who were examined and treated in the outpatient/inpatient settings between 2008 and 2010 were retrospectively analyzed using patient files and the hospital electronic database. Sample size A total of 1020 patients diagnosed with thrombocytopenia. Results The patients were divided into groups according to the most common diagnoses for diseases associated with thrombocytopenia (hematological malignancy, disseminated intravascular coagulation (DIC)-sepsis, immune thrombocytopenia (ITP), infection, and chronic liver disease (n=708). Chemotherapy-induced, drug-induced, nutritional (B12, folate deficiency, etc.), OKIT, pregnancy-induced thrombocytopenias and other less common causes of thrombocytopenia were evaluated in a separate group (n=312). It was found that female patients were more frequently diagnosed with ITP (71.7 vs. 28.3%). Sex distributions were similar in other groups. The highest mean age (71 years: 50/80) was observed in patients with DIC-sepsis, whereas the lowest mean age was found in patients with ITP (40 years: 30/57) (P<0.001). It was found that the most frequent need for transfusion developed in patients diagnosed with acute myeloid leukemia, acute lymphoblastic leukemia, and aplastic anemia. Conclusion In this study, it was determined that the prevalence of thrombocytopenia was highest in patients diagnosed with hematological malignancy, ITP, and DIC-sepsis, respectively. In cases of hematological malignancy, the need for replacement of blood products is considered to be inevitable during the treatment process of the underlying disease compared with other clinical conditions.

Trombocitopenija i KOVID-19 - diferencijalna dijagnoza i terapija

Thrombocytopenia represents a common manifestation of COVID-19 with a prevalence of up to 35% in certain studies. A low platelet count is an unfavorable prognostic marker in SARS-CoV-2 infected patients. Despite a large number of publications dealing with the prognostic significance of thrombocytopenia in COVID-19, data regarding the differential diagnosis and therapy are scarce. The most common causes of thrombocytopenia in COVID-19 are shown in this review, namely: SARS-CoV-2-induced thrombocytopenia; disseminated intravascular coagulopathy (DIC); immune thrombocytopenia; drug-induced thrombocytopenia, with a special insight into heparin-induced thrombocytopenia (HIT). Although a majority of patients suffer from mild thrombocytopenia and do not require any particular treatment, there are some cases of severe thrombocytopenia which may cause life threatening bleeding. On the other hand, some forms of thrombocytopenia, such as DIC or HIT, carry a high risk of the development of thrombotic events, which is why anticoagulant prophylaxis is required in these patients. At the end of each section of this review, treatment recommendations are given for each aforementioned type of thrombocytopenia developing in COVID-19.

Severe Immune Thrombocytopenia Post-COVID-19: A Case Report

Immune thrombocytopenia, also called idiopathic thrombocytopenic purpura, is a common cause of thrombocytopenia after viral infections. Even in the second year of the coronavirus disease 2019 (COVID-19) pandemic, our body of knowledge regarding the diverse symptoms and complications of the virus continues to grow and evolve. We present a case of a 48-year-old African American male who came into the emergency department with severe left foot pain. A platelet count of 7x103/mL was incidentally found on complete blood count (CBC) during the patient's initial workup. The patient had previously been hospitalized for COVID-19 five weeks prior. Further workup did not support any etiology of his thrombocytopenia. Therefore, we gave a presumed diagnosis of idiopathic thrombocytopenic purpura secondary to COVID-19. The patient was treated with corticosteroid resulting in improvement in his platelet count.

Does Autoimmunity in Family Members of Children with Immune Thrombocytopenia Help Identify Patients at Higher Risk of Chronic Immune Thrombocytopenia?

BackgroundImmune thrombocytopenia (ITP) is the most common cause of thrombocytopenia during childhood. Approximately 10-30% of pediatric patients will develop chronic ITP (cITP), which is defined as thrombocytopenia lasting over 12 months, and constitutes a significant burden for patients and their caregivers. Patients with cITP may require ongoing medications to treat symptomatic thrombocytopenia, may have asymptomatic thrombocytopenia not requiring medical interventions, or may experience complete resolution of their ITP. There are not specific patient nor disease characteristics that can help us predict how cITP may progress, and which patients are more likely to require ongoing treatments. ITP can be a manifestation of immune dysregulation in patients with other autoimmune conditions or primary immunodeficiency disorders (PIDDs). We aimed to assess the characteristics of patients with cITP including the presence of autoimmune or allergic disorders in the patients and in first-, second-, and third-degree family members. We hypothesized that patients with cITP may have a higher incidence of immune dysregulation in family members in contrast to patients with acute aITP.MethodsThe study was approved by the institutional review and ethics boards at the University of Utah. We queried the Primary Children's Hospital database for cases of “immune thrombocytopenia” from January 1 st, 2001 to January 1 st,2021. Retrospective chart review was done to confirm the diagnosis. Patient demographics, clinical presentation, and family history of patients were reviewed. Data was collected in RedCap at the University of Utah. Descriptive summaries of data were done.ResultsMedical charts from 266 ITP patients diagnosed during the study period were reviewed; 182/266 (68.5%) had acute ITP (aITP) and 84/266 (31.5%) patients had cITP, defined as platelet count <150 K/µl for >12 months. Resolution of ITP occurred in 28/84 (33.3%) patients with cITP (resolved cITP), while 56/84 (66.7%) had ongoing thrombocytopenia (unresolved cITP). Mean duration of ITP in patients with resolved cITP was 2.9 years, and 4.6 years in patients with unresolved cITP at the time of the last known platelet count. Mean age at diagnosis was 7.4 years in the cITP group and 5.1 years in the aITP group.Concurrent allergic conditions were identified in 10/84 (12%) of patients with cITP and 5/182 (2.7%) of patients with aITP. Autoimmune conditions were identified in 3 patients (3.5%) with cITP, and 4 patients (2.2%) with aITP. First-degree family members of cITP patients were more likely to be reported with an autoimmune condition than first-degree family members of aITP patients (15.5% vs. 5.5%, p=0.007 using Chi-square test); this effect was not seen amongst second- or third-degree relatives. The most common autoimmune condition reported in family members was autoimmune thyroid disease in both cohorts (2.7% in aITP and 9.5% in cITP). Common variable immunodeficiency (CVID) was reported in second degree relatives of 3/84 (3.6%) patients with cITP; no relatives of patients with aITP had a report of PIDD. Additionally, we identified 14 patients with Evans syndrome (ES), all with chronic immune thrombocytopenia and all patients had been followed for over a year at the time of the chart review. Four ES patients were previously diagnosed with 22q11.2 deletion, and one with CVID. In patients with ES, 4/14 (28.6%) and 5/14 (35.7%) had first- and second-degree family members with a reported autoimmune condition, respectively. No PIDDs were identified in first, second-, or third-degree relatives of patients with ES.ConclusionsThere is increasing evidence that patients with chronic ITP may exhibit polyautoimmunity or other signs of immune dysregulation, suggesting that ITP may be the initial manifestation of another autoimmune process or PIDD. We evaluated medical histories of patients with ITP and their family members. Patients with cITP have a history of autoimmunity in their family stronger than in patients with aITP. This association was even stronger in patients with ES. DisclosuresNo relevant conflicts of interest to declare.

Prognostic evaluation of immune thrombocytopenia outcomes in Egyptian children: a retrospective single-center experience

Immune thrombocytopenia (ITP) is the most common cause of thrombocytopenia in children. This retrospective study was designed to analyze presenting features of ITP cases in Benha, evaluate outcomes in children and determine prognostic factors. This research was accepted by Research Ethics Committee (REC) of Faculty of Medicine, Benha University (chairman: Prof. Nermeen Adly Mahmoud). Ethics comittee refrence number MS 40-3/2019. Records of 308 children with ITP in Benha University Hospitals and Benha Children Hospital haematology clinics between May 2014 and January 2021 were retrospectively analyzed. Socio-demographic, clinical, and laboratory data of the studied children such as age, gender, the type of residence, the date of diagnosis, complaints at presentation, preceding vaccination or infection, the type of bleeding, initial platelet count, LDH (lactate dehydrogenase) level, initial treatment, and outcomes were recorded. A total of 308 children diagnosed with ITP were included, clinical courses were determined as newly diagnosed and chronic in 71.4% and 28.6%, respectively. The median age of patients at diagnosis was 5 ± 3.4 years. The male/female ratio was 1.14. The median age at diagnosis was significantly higher in chronic ITP patients (p &lt; 0.001); patients ≥ 10 years were more likely to develop chronic ITP than younger ones (p = 0.029). Regarding residency, seasonality, type of bleeding and history of preceding infection or vaccination, the difference was not statistically significant. Initial platelet counts &gt; 20 × 109 were significantly more prevalent in chronic ITP (p &lt; 0.001). LDH level at presentation was significantly higher in chronic cases (p = 0.046). Initial lines of treatment were the following: steroids, IVIG, and IVIG with steroids (in 88%, 5.2%, and 2.9% of the cases, respectively). A total of 3.9% of the children did not receive any treatment. There was no significant difference in the outcomes between the initial lines of treatment (p = 0.105). In our study, age &gt; 10 years, female gender, higher platelet count and high LDH level at presentation were found to increase the probability of chronic ITP.

Сучасні підходи до перинатального менеджменту при тромбоцитопенії під час вагітності

The most common diseases of the blood system in pregnant women are anemia and thrombocytopenia (TP). There is a general tendency to significantly reducing of the number of platelets during pregnancy, starting from the first trimester with a minimum number of them during childbirth. Purpose — to learn the features of motion of pregnancy, diagnostic and curative tactician at the thrombocytopenia during pregnancy. The causes of TP during pregnancy are three groups of conditions — conditions for which TP is characteristic outside of pregnancy and conditions associated with pregnancy: gestational thrombocytopenia (GTP), pregnancy-specific complications, manifestations of diseases characterized by TP, with the chief reason among them — immune thrombocytopenia (ITP). The most common cause of TP during pregnancy is GTP, which, like ITP, is diagnose of exclusion that require differential diagnosis. The goal of treating TP during pregnancy is to achieve a safe platelet count that is different for each trimester, not target values. If the treatment of ITP is need lines of therapy with control of efficiency are consistently applied. Pregnant women with moderate and severe TP are a group of high perinatal risk, requiring careful differential diagnosis of the causes of TP, calculation of maternal and fetal risks, choice of tactics of such pregnancy, method and time of delivery, formation of postnatal care plan. No conflict of interest was declared by the authors. Key words: pregnancy, thrombocytopenia, immune thrombocytopenia, gestational thromocytopenia.

“MATERNAL OUTCOME IN PREGNANCY WITH THROMBOCYTOPENIA”

INTRODUCTIONThrombocytopenia is diagnosed when the platelet count is less than 1,50,000 per microliter of blood It is a common hematological disorder Thrombocytopenia is divided into 3 types according to severity: mild (100,000 to 150,000), moderate (50,000to100,000) and severe (less than 50,000) thrombocytopenia. MATERIALAND METHODObjective- To study the incidence of thrombocytopenia in normal pregnancy. to study the maternal and fetal outcomes in pregnant patients with thrombocytopenia This is a retrospective study in which a total of 1202 patients delivered in a maternity hospital of Gwalior from 1 January 2018 to 30 June 2019 were studied. 72 patients with a platelet count below 1.5 lakhs were included in the study. RESULTSA total of 1202 patients were delivered during the study period out of the 72 patient had thrombocytopenia thus the prevalence was found to be 5.99%. rd In our study majority of the patients were multigravida 63.88% in the 3 trimester 54.16% majority by between age of 25-30 years 58.33%. In our study 61.11% of women had mild, 27.77 had moderate and 11.11% had severe thrombocytopenia. In this study, gestational thrombocytopenia was the most common etiological factor with 29.16% of cases. In our study, 70.83% of patients were delivered vaginally and 29.16% of patients were delivered by LSCS. No complication was reported in 48.61% of patients. The bleeding during CS was found in 4.16% cases, maternal hemorrhage was found in 5.55%, pulmonary edema in 5.55%, ARF in 5.55%, DIC 4.16%, and Puerperal sepsis in 2.77%. Blood transfusion was needed in 15.27% of patients, platelet transfusion in 4.16% of patients. Obstetric hysterectomy was done in 1 patient. During the study, 2 maternal death were reported due to the HELLPsyndrome and associated complications. CONCLUSIONGestational thrombocytopenia is the most common cause of thrombocytopenia during pregnancy. We conclude that early diagnosis of thrombocytopenia in pregnancy is essential for better maternal and fetal outcomes. It is important to determine the exact etiological cause of thrombocytopenia so that timely management can be provided to the pregnant patients to decrease the complication rate thus, timely diagnosis, frequent monitoring, and treatment is must achieve a better outcome.

Immune and Non-Immune Etiology of Thrombocytopenia: Neonatal and Maternal Causes

Neonatal thrombocytopenia (NT) is a common hemostatic abnormalitiy among newborn in the NICU, which increases with the degree of prematurity. It is well documented that this disease has a large range of feasible etiologies. Prematurity, early and late-onset sepsis and asphyxia are the most usual causes of NT. Moreover, FNAIT is the major risk for intracranial hemorrhage in the fetus or newborn. Here, we reviewed the causes for NT, in both newborns and mothers. We demonstrated the factors associated with NT in the newborn including placental insufficiency, fetal and neonatal alloimmune thrombocytopenia (FNAIT), prematurity, sepsis, and asphyxia. The causes of thrombocytopenia in pregnant women and its impact on newborns were also described. This review showed that gestational thrombocytopenia was the most common cause of thrombocytopenia with an incidence of 70-80%, followed by preeclampsia, HELLP and ITP. But neonates born to mothers with immune thrombocytopenia (ITP) had a higher risk for NT and hemorrhagic problems. In ITP, neonatal platelets are destroyed by maternal autoantibodies. We reviewed the causes of thrombocytopenia in neonates and mothers in two groups of immune and nonimmune factors. However, it seems that immunological factors are the most severe form of NT. However, it is necessary to separate NT etiology for differential diagnosis.

Evaluation of Thrombocytopenia: A Prospective Study at Sree Balaji Medical College and Hospital, India

Thrombocytopenia is a physiological deficiency in platelet counting. Fragmented RBC can be a chronic trigger for a subclinical micro angiopathy that results in chronic consumption of platelets. The platelet is a small, lentiform, anucleated cell that play a vital role in hemostasis and are produced in the bone marrow from megakaryocytes. To evaluate different etiological factors of thrombocytopenia by the study of clinical profile and laboratory parameters in patients with thrombocytopenia carried out in Sree Balaji Medical College and Hospital, Chennai. After evaluating all cases of thrombocytopenia, it is concluded that infective causes are more common than non-infective causes. Infections like dengue, malaria and septicemia were the common causes of thrombocytopenia along with megaloblastic anemia. Whenever thrombocytopenia is detected, a further investigation has to be done for specific diagnosis in the most of the cases so that appropriate treatment can be given.

Evidence-based clinical practice guideline for the management of primary immune thrombocytopenia (ITP) in pediatric population

Introduction: Primary immune thrombocytopenia (ITP) is the most common cause of thrombocytopenia in children, with a reported incidence of 1.1-12.5 cases per 100 000 children. However, currently, there are several definitions of ITP, as well as diagnostic and therapeutic approaches. Objective: To develop an evidence-based clinical practice guideline (CPG) to standardize the definition of ITP and, in this way, reduce the variability of its diagnosis, and to provide indications for the treatment of acute, persistent, and chronic ITP in patients under 18 years of age. Materials and methods: The CPG was prepared by a multidisciplinary group that followed the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) guidelines for developing CPGs, formulated PICO clinical questions, and conducted systematic reviews. GRADE evidence profiles were created and recommendations, with their corresponding level of evidence and strength, were made after a panel of experts assessed the benefit-risk balance, the quality of evidence, the patients’ values and preferences, and the context in which they should be implemented. Results: A total of 23 recommendations were made to pediatricians, hematologists, and health professionals working in emergency services for treating acute, persistent, and chronic ITP. Overall, the CPG has low quality of evidence, and the recommendations were made in order to improve the success rate of ITP treatment and the prognosis of children with this condition. Conclusions: Although ITP is the main cause of thrombocytopenia in pediatrics, to date there is not enough high-quality evidence that supports the recommendations presented here for its proper classification and treatment in children. Thus, further studies providing high-quality evidence on this issue are required.

English

BACKGROUND Fever is the commonest cause of thrombocytopenia that narrows the differential diagnosis and management of fever. The complexity of thrombocytopenia and its control can also be determined through fever. Lack of proper surveillance system and limited laboratory services pose a definite challenge for a perfect diagnosis leading to case management primarily based on clinical manifestations. METHODS A cross-sectional study was conducted on 90 patients attending outpatient department of Vinayaka Missions Kirupananda Variyar Medical College &amp; Hospitals, during the period of April 2017 to September 2017 (6 months). In patients with fever with thrombocytopenia, a careful history was recorded, general physical examination, laboratory and technical investigation reports were noted down from regular investigations. Culture sensitivity and serology were considered as primary outcome variables. The continuous data was expressed as mean ± standard deviation (SD) and for independent sample “t” test was used to compare the data. A probability value (“P” value) of ≤ 0.05 at 95 % confidence interval was considered as statistically significant using Statistical Package for the Social Sciences (SPSS). RESULTS The mean age was 44.73 ± 21.18 years in the study population. 39 (43.33 %) were males and 51 (56.67 %) were females. The average period of stay in the hospital was 8.84 ± 5.73 days; the most common chief complaint was chills &amp; rigors seen in 65 (72.22 %) patients. The most commonly observed comorbidity in the patients was diabetes mellitus. The mean and SD of platelet count was 91522.22 ± 32265.13 per µL. 21 (23.33 %) people had dengue. The mean platelet count at discharge was 192215.19 ± 49481.85 per µL. CONCLUSIONS The commonest cause is infection, for fever with decreased platelet count. A significant number of cases of febrile thrombocytopenia were diagnosed as sepsis in the present study. KEYWORDS Infection, Dengue, Septicaemia, Petechiae / Purpura, Spontaneous Bleeding, Fever

Thrombocytopenia and its effect on mortality and morbidity in the intensive care unit

Background/Aim: Thrombocytopenia is a common hematological abnormality among patients in the intensive care unit (ICU). The development of thrombocytopenia in the ICU usually indicates severe organ system dysfunction rather than a primary hematological disorder. We aimed to determine the incidence, causes, and clinical results of thrombocytopenia in patients followed up in ICU. Methods: In this retrospective cohort study, 165 patients who were followed up in the ICU with thrombocyte counts below 150,000 /uL were included and causes of thrombocytopenia, along with its effects on mortality and intensive care stay were investigated. Results: Thrombocytopenia was determined in 30.1% of the patients in the ICU. The cause of thrombocytopenia was sepsis in 33 (20.0%) of the patients and disseminated intravascular coagulation (DIC) in 20 (12.1%) patients. During the study period, 115 (69.7%) of 165 thrombocytopenic patients and 173 (45.1%) of 383 patients without thrombocytopenia died. Mortality was significantly higher in patients with thrombocytopenia. Mortality significantly increased when platelet count decreased, even with similar APACHE II scores. Conclusion: The most common causes of thrombocytopenia in the ICU were sepsis and DIC. Thrombocytopenia is common in the ICU and increases mortality rates.

Thrombopoietin receptor agonist for treatment of immune thrombocytopenia in pregnancy: a narrative review.

The treatment of immune thrombocytopenia (ITP) in adults has evolved rapidly over the past decade. The second-generation thrombopoietin receptor agonists (TPO-RAs), romiplostim, eltrombopag, and avatrombopag are approved for the treatment of chronic ITP in adults. However, their use in pregnancy is labeled as category C by the United States Food and Drug Administration (FDA) due to the lack of clinical data on human subjects. ITP is a common cause of thrombocytopenia in the first and second trimester of pregnancy, which not only affects the mother but can also lead to thrombocytopenia in the neonatal thrombocytopenia secondary to maternal immune thrombocytopenia (NMITP). Corticosteroids, intravenous immunoglobulins (IVIGs) are commonly used for treating acute ITP in pregnant patients. Drugs such as rituximab, anti-D, and azathioprine that are used to treat ITP in adults, are labeled category C and seldom used in pregnant patients. Cytotoxic chemotherapy (vincristine, cyclophosphamide), danazol, and mycophenolate are contraindicated in pregnant women. In such a scenario, TPO-RAs present an attractive option to treat ITP in pregnant patients. Current evidence on the use of TPO-RAs in pregnant women with ITP is limited. In this narrative review, we will examine the preclinical and the clinical literature regarding the use of TPO-RAs in the management of ITP in pregnancy and their effect on neonates with NMITP.

Maternal and fetal outcome of pregnancies complicated with thrombocytopenia

Thrombocytopenia is defined as a platelet count below the lower limit of normal range (typically &amp;#60; 150,000/ microL). It is second only to anemia as the most common hematological abnormality encountered during pregnancy. Thrombocytopenia complicates about 7-8% of all pregnancies, especially in third trimester; it most frequently represents a complication not requiring treatment. Evaluation and management of thrombocytopenia during pregnancy and postpartum may be challenging because there are many potential causes, some directly related to pregnancy and some unrelated. For many causes there are no diagnostic laboratory tests.This topic reviews our approaches to determining causes of thrombocytopenia in a pregnant women and its impact on newborns while looking to stratify the risk according to etiology and severity of parturient’s hematological condition.In our study Gestational thrombocytopenia was the commonest cause of thrombocytopenia with incidence of 70%, followed by Preeclampsia (22%), HELLP (4%), ITP (2%) and Dengue (2%).Gestational thrombocytopenia is the commonest cause of thrombocytopenia and may not be related to adverse pregnancy outcome, thus can be treated as benign condition. Clinical assessment is most important factor for evaluating a patient with thrombocytopenia.Monitoring of platelet count of pregnant women should be a routine at antenatal visits for timely diagnosis and to achieve favorable feto- maternal outcome in all types of thrombocytopenia. Neonatal platelet count should be done in all mothers diagnosed with thrombocytopenia.After detailed evaluation of the data, we came to the conclusion that with proper care and precautions, readiness to deal with complications, thrombocytopenia does not pose significant impact on maternal and fetal morbidity and mortality when compared to normal population.

Clinicopathological overview of thrombocytopenia: A retrospective study in tertiary care hospital

Introduction: Thrombocytopenia is not a disease itself, but a subnormal number of platelets in blood and is one of the most common causes of abnormal bleeding. The patient with thrombocytopenia often presents diagnostic and management challenges. The differential diagnosis is broad because the disorders leading to thrombocytopenia are diverse, with failed production at one extreme and the accelerated destruction at the other. Aims and Objective: To highlight and diagnose thrombocytopenia and investigate the cause of thrombocytopenia in our tertiary care center. Materials and Methods: The present study is retrospective, cross sectional study done on screened 389 thrombocytopenia patients which were came to our hematology lab. All patients of proved thrombocytopenia patients were included in the study over a period of 3 years from May 2013 to April 2016. Pseudo-thrombocytopenia patients were excluded from the study. All these patients were investigated in a systemic manner, causes of thrombocytopenia were ascertained and data was analyzed. Results: The most common affected age group of thrombocytopenia was 3rd decades and 2nd decades respectively with male predominance. The most common cause of thrombocytopenia is anemia, infection, spleenomegaly and alcoholism. Dimorphic anemia, malaria and HIV are the most etiology of anemia and infection respectively. Conclusion: Thrombocytopenia is root cause of abnormal bleeding in many cases. Importance of early and prompt diagnosis of thrombocytopenia is always warranted as treatment differs depending upon the etiology. Thrombocytopenia is multifactorial and a finding that may result from various diseases and clinicopathological approach is important in these cases. Keywords: Thrombocytopenia, Platelets, Etiology, Multifactorial, Clinicopathological.

Major Bleeding Outcomes for Admitted Immune Thrombocytopenia Patients with Platelets Less Than 10K: A Single Center Experience

Introduction Immune thrombocytopenia (ITP) is one of the most common causes of thrombocytopenia in adults. Majority of patients are asymptomatic or might have symptoms primarily related to mucocutaneous or minor bleeding events, while severe bleeding is uncommon. ITP patients who develop severe bleeding require urgent hospitalization, but asymptomatic/minor bleeding patients might be successfully treated as outpatient. In several occasions, the latter group of patients are admitted to the hospital to initiate treatment when their platelets are very low (i.e. less than 10K). In this study we aimed to evaluate the incidence of major bleeding and medical necessity for admitting this group to the hospital. Methods We conducted a retrospective chart review of 559 charts with an ICD code of ITP between March 2017 to March 2020. We excluded all patients who presented with a platelet above 10K, other co-existing hematological disorders or malignancies, first presentation with platelets less than 10K with no prior known history of ITP, and charts of patients who left against medical advice prior to initiation of treatment. The definition of major bleeding included intracranial hemorrhage, or any bleeding with more than 1 gm hemoglobin drop. Minor bleeding included epistaxis, gum bleeding, hematuria, vaginal or minor GI bleeding that didn't result in hemoglobin drop. We found a total of 66 ITP patients who were admitted to the hospital because of platelet count of less than 10K, of which 54 had minor or no bleeding episode, while 12 patients presented with major bleeding episode. Results Between the period of March 2017 to March 2020, a total of 66 patients with a known history of ITP were admitted to the hospital with platelet count of less than 10K, of which 54 patients (82%) had either only minor bleeding (n=10), or no evidence of bleeding (n=44) and 12 patients (18%) presented with major bleeding. The major bleeding events were distributed as follows: Hematuria due to kidney stone (n=1), traumatic ICH ((n=4), spontaneous ICH (n=1), and GI bleed (colon mass (n=1), erosive gastropathy(n=1), angiodysplasia (n=1), esophageal varices (n=2), and gastric ulcer (n=1)). None of the asymptomatic/minor bleeding patients developed any major bleeding event before, during or after hospitalization. The average LOS for asymptomatic/minor bleeding patients was 4.65 days (range 1-45 days), compared to 9.14 days (range 2-20 days) for patients with major bleeding. All the 12 patients (100%) with major bleeding received platelet transfusions during hospitalization, while 23 asymptomatic/minor bleeding patients (42%) received platelet transfusion. Discussion Major bleeding in patients with acute ITP is usually a clear indication for hospitalization, however there is lack of data to support admitting asymptomatic/minor bleeding ITP patients when platelets are less than 10K. Our data showed that no major bleeding event has developed in asymptomatic/minor bleeding patients at time of presentation, during hospitalization or after discharge. All 12 patients with major bleeding presented with a bleeding event that warranted their admission, of which 1 patient had spontaneous bleeding, while the rest had a clear medical reason for the major bleeding, which was likely exacerbated by thrombocytopenia. Since assessing the risk of bleeding is an important step in considering prophylactic platelet transfusion for those with platelets less than 10K, 42% of asymptomatic/minor bleeding patients received platelet transfusion during admission indicating that more than half didn't have high risk features. Inpatient hospitalization carries a high financial burden on both the patient and the healthcare system, increases the risk of hospital acquired infections and in-hospital complications. Asymptomatic/Minor bleeding patients in our study had average LOS of 4.65 days, and all were treated with regimens that can be given as an outpatient including steroids, IVIG, and in some occasions Rituximab and/or thrombopoietin stimulating agents increasing the cost of their hospital stay. Based on our observation, we are able to conclude that this particular group of patients would possibly benefit from close monitoring of signs and symptoms, labs, and treatment all in the outpatient setting. Further studies are needed to evaluate the cost effectiveness and long-term outcome in these patients. Disclosures No relevant conflicts of interest to declare.

SEVERE IMMUNE THROMBOCYTOPENIA IN A PATIENT WITH HIV-HCV COINFECTION

Thrombocytopenia in a patient with HCV – HIV co-infection can hav e a multitude of causes. Thrombocytopenia is seen in 5-30% of HIV patients.1 The most common cause of thrombocytopenia in HIV patients is HIV-associated thrombocytopenia. The aetiology for HIV associated thrombocytopenia is complex and is due to both immune mediated peripheral destruction of platelets as well is reduced platelet production from the progenitor cells. However secondary causes of thrombocytopenia needs to be ruled out in all patients with HIV infection. Common secondary causes for thrombocytopenia include infections (viral, bacterial, fungal and parasitic), malignancies, drugs, hypersplenism and other causes of cirrhosis. In our patient no secondary cause could be found except for co- infection with Hepatitis C virus.

Treatment lines of childhood chronic ITP: A retrospective single-center analysis

Immune thrombocytopenia (ITP) is the most common cause of thrombocytopenia in children. Approximately 20–25% of children develop a chronic course of the disease. Many treatment options are available, including chronic use of first-line therapies, e.g., corticosteroids, intravenous immunoglobulin or anti-Rh-D, and second-line therapies, including dexamethasone, high-dose methylprednisolone, intensive immunosuppressants, rituximab, thrombopoietin receptor agonists (TPO-RAs), splenectomy, and many others; however, none of these treatments have been determined to be the best. In this study, we retrospectively reviewed the course, response to different treatment lines and outcome of children with chronic ITP over a period of ten years to compare the efficacy of different treatment options, aiming to determine a scale of priority for selecting the most costeffective treatment. A retrospective study was conducted and included children diagnosed with chronic ITP from January 2008 until December 2018 who were followed at the Pediatric Hematology Unit of Mansoura University Children Hospital, Mansoura, Egypt. The study proposal was approved on February 14, 2017 (approval No 17.02.59) by the Institutional Review Board (IRB) of the Faculty of Medicine, Mansoura University, Egypt. All research steps were conducted according to the Declaration of Helsinki. The diagnosis of chronic ITP was based upon the persistence of thrombocytopenia lasting for more than 1 year with or without therapy. Bone marrow aspiration was performed for all patients to confirm the diagnosis of chronic ITP and exclude other causes of thrombocytopenia. Data relevant to chronic ITP patients diagnosed from 2008 to 2018 were retrieved from the Electronic Data System of Hospital Management of Mansoura University Children Hospital, including age, sex, diagnosis date, duration of chronicity, treatment given during the chronic phase and response. Treatment regimen was immune modulatory therapies (high-dose dexamethasone, IV rituximab or low-dose dexamethasone + azathioprine), thrombopoietin receptor agonists (TPO-RAs) (eltrombopag or romiplostim). Out of 405 newly diagnosed ITP patients in a period of 10 years in our center, 103 progressed to chronic disease, of whom 29 were lost to follow-up, while 74 patients were followed at the hematology outpatient clinic and enrolled in the current study (32 males and 42 females, median age – 10 years, median initial platelet count – 16 × 109 /l). Approximately one-third of patients (25~33.8%) were managed conservatively; of them, 19 patients achieved sustained remission, and 6 patients needed another treatment line. Forty-six (62%) patients received immunomodulatory therapies. Twentyeight patients (37.8%) were treated with TPO-RAs. No differences were observed between the 3 types of immunomodulatory therapies regarding relapse-free survival and duration of remission (р value: 0.7). Additionally, no differences were noted according to relapse-free survival among those treated with eltrombopag and romiplostim (р value: 0.7). The number of male children who had a sustained response was significantly higher than that of female children among patients receiving immunomodulatory therapies (71.4% vs 28.6%, respectively) (р value 0.01). There were significantly more patients on TPO-RA with a sustained response than patients on immune modulators, and consequently, the number of patients who relapsed on immunomodulators was higher than that of those on TPO-RA (67.9% vs 30.4% compared to 69.9% vs 32.1%, р value 0.01). Many of our patients who received immunomodulators and failed to achieve or lost a response before 2015 were switched to TPO-RAs with comparable efficacy apart from sustainability, which was in favor of the latter. Additionally, among the types of immunomodulators, rituximab did not show superior efficacy compared to other types, with lower costs for the latter, leading to the abandonment of its use, particularly in limited resource countries such as ours.