Immune Thrombocytopenic Research Articles

Gene mutations in the PI3K/Akt signaling pathway were related to immune thrombocytopenia pathogenesis.

Immune thrombocytopenic (ITP) is an autoimmune bleeding disease with genetic susceptibility. Twenty newly diagnosed active primary ITP patients who had not been treated with glucocorticosteroids, immune globulin or immunosuppressants prior to sampling were enrolled in this study. Bone marrow blood mononuclear cells were used for whole exome sequencing to further elucidation the variant genes of ITP. High-molecular-weight genomic DNA was extracted from freshly frozen bone marrow blood mononuclear cells from 20 active ITP patients. Next, the samples were subjected to molecular genetic analysis by whole-exome sequencing, and the results were confirmed by Sanger sequencing. The signaling pathways and cellular processes associated with the mutated genes were identified with gene ontology and Kyoto Encyclopedia of Genes and Genomes pathway analyses. The results showed that there were 3998 missense mutations involving 2269 genes in more than 10 individuals. Unique genetic variants including phosphatase and tensin homolog, insulin receptor, and coagulation factor C homology were the most associated with the pathogenesis of ITP. Functional analysis revealed these mutation genes mainly affect Phosphatidylinositol 3 kinase/serine/threonine kinase B signaling pathways (signal transduction) and platelet activation (immune system). Our finding further demonstrates the functional connections between these variant genes and ITP. Although the substantial mechanism and the impact of genetic variation are required further investigation, the application of next generation sequencing in ITP in this paper is a valuable method to reveal the genetic susceptibility.

PATHOPHYSIOLOGY, INVESTIGATIONS, AND TREATMENT OF PATIENTS WITH IMMUNE THROMBOCYTOPENIC PURPURA

PATHOPHYSIOLOGY, INVESTIGATIONS, AND TREATMENT OF PATIENTS WITH IMMUNE THROMBOCYTOPENIC PURPURA

IMMUNE THROMBOCYTOPENIC PURPURA - TREATMENT AND ASSOCIATION WITH COVID-19

IMMUNE THROMBOCYTOPENIC PURPURA - TREATMENT AND ASSOCIATION WITH COVID-19

HEPATITIS E: A RARE CAUSE OF IMMUNE THROMBOCYTOPENIC PURPURA

Acute viral hepatitis in children usually is a self-limiting mild disease which does not require any specific treatment. It is most commonly caused by hepatotropic viruses, hepatitis A and hepatitis E virus spread by the feco-oral route. Hepatitis E infection mostly follows an asymptomatic and anicteric course in the younger age group than icteric hepatitis. Rarely, they cause cholestatic hepatitis and fulminant hepatitis. It may rarely be associated with various extra-hepatic autoimmune manifestations. We herein report an extremely rare case of immune thrombocytopenia in a young girl associated with acute hepatitis E infection, who had an uneventful course on conservative management. She presented to us with nausea, vomiting, lethargy, jaundice, and petechial spots. On examination and investigating further, the patient had features of immune thrombocytopenic purpura and positive serology for IgM hepatitis E, whereas, a workup for other causes was normal.

Maternal and Neonatal Idiopathic Thrombocytopenic Purpura

Immune thrombocytopenic (ITP) is an autoimmune disease that affects 9.5/100,000 adults in the population.1 It is characterized by autoimmune destruction of platelets leading to potentially life-threatening thrombocytopenia. About 7% of pregnant mothers are affected by thrombocytopenia with 1 to 10 per 10,000 mothers being affected with ITP. Studies have shown that ITP is generally a benign condition in the birthing mother and rarely has a long-lasting effect on the newborn child.2 In the rare event that the newborn is severely affected, treatment is required. We present a case of ITP in both a mother and her newborn.

Использование высокогорного климата в терапии детей с идиопатической тромбоцитопенической пурпурой в Киргизской Республике

Введение. Вопрос о дальнейшем совершенствовании базисной терапии идиопатической тромбоцитопенической пурпуры (ИТП) по-прежнему широко обсуждается специалистами и является предметом оживленных дискуссий. Цель исследования: изучить динамику геморрагического синдрома и количества тромбоцитов у детей с ИТП в процессе высокогорной климатотерапии и оценить эффективность воздействия высокогорной гипоксии на течение болезни. Материалы и методы. В исследование включено 24 ребенка с хронической ИТП в возрасте от 5 до 14 лет (средний возраст — 10,25 ± 1,43 года) с длительностью заболевания от 4 до 8 лет. Для лечения детей поднимали на высокогорную базу Туя-Ашу (перевал Туя-Ашу, 3200 м над уровнем моря). Продолжительность лечения в высокогорье составляла 40 дней. Результаты. К концу срока пребывания в горах значительно уменьшались проявления геморрагического синдрома, полностью купировался анемический синдром, количество тромбоцитов достоверно увеличивалось с минимума 22,1 × 109/л до максимума 108,4 × 109/л. Заключение. Из 22 детей, получивших высокогорную климатотерапию, у 2 детей достигнута полная и у 15 — частичная ремиссия. У 4 детей улучшение клинико-гематологических показателей носило временный характер, и отсутствие эффекта зарегистрировано у 1 ребенка. Ремиссия достигнута у 77% больных детей. Introduction. Further improvement of the basic therapy of idiopathic thrombocytopenic purpura (ITP) is still widely discussedby specialists and is the subject of lively discussions. Aim: to study the dynamics of hemorrhagic syndrome and platelet count in children with ITP in the process of high-altitude climatotherapy and assess the eff ectiveness of high-altitude hypoxia exposure on the course of the disease. Materials and methods. The study included 24 children with chronic ITP aged 5 to 14 years (mean age — 10.25 ± 1.43 years) with disease duration from 4 to 8 years. For treatment children were raised to Tuya-Ashu high-altitude base (mountain pass Tuya Ashu, 3200 m above sea level). The duration of treatment in highlands was 40 days. Results. By the end of the treatment, the manifestations of hemorrhagic syndrome decreased signifi cantly, the anemic syndrome completely stopped, the platelet count increased significantly from minimum of 22.1 × 109/L to maximum of 108.4 × 109/L. Conclusion. High-altitude climatotherapy received 22 children, 2 children had complete remission and 15 — part remission. In 4 children the improvement of clinical and hematological parameters was temporal, and the absence of eff ect was registered in 1 child. Remission was achieved in 77% of ill children.

Post-Partum Thrombotic Thrombocytopenic Purpura (TTP) in a Patient with known Idiopathic (Immune) Thrombocytopenic Purpura: a case report and review of the literature

BackgroundIncidences of immune thrombocytopenic purpura occur in 1 in every 1000–10,000 pregnancies accounting for 3% of all thrombocytopenic pregnancies. A pre-existing immune thrombocytopenic purpura is known to be a risk factor for developing thrombocytopenia during pregnancy. We present here the treatment regime and management of a patient with known immune thrombocytopenic purpura who developed postpartum thrombotic thrombocytopenia with atypical response to traditional therapy.Pregnant women are more vulnerable to immune thrombocytopenic purpura or thrombotic thrombocytopenia. Pregnancy or postpartum thrombotic thrombocytopenia accounts for 10–25% of all thrombotic thrombocytopenia.Case presentationThis case report deals with the treatment regime and management of a patient with known immune thrombocytopenic purpura who developed postpartum thrombotic thrombocytopenia. A 30-year-old Middle Eastern woman, with a prior diagnosis of chronic immune thrombocytopenic purpura had remained off-the-treatment for many years. After primary unexplained infertility for 8 years, for which she underwent six failed trials of in vitro fertilization, she delivered a healthy baby through caesarean section. Two days post-surgery, she had persistent thrombocytopenia, ecchymoses, bruises, and hemolysis. Her blood film revealed leukoerythroblastic anemia. Her blood tests also revealed a very low level of haptoglobin, and low level of ADAMTS13. A diagnosis of thrombotic thrombocytopenia was suspected. Plasma exchange therapy was started with partial response. We showed that rituximab in conjunction with mycophenolate mofetil following plasma exchange therapy was effective in controlling the low platelet count in our patient.ConclusionsRituximab in conjunction with mycophenolate mofetil following plasma exchange therapy was effective in controlling the low platelet count in our patient. Only two doses of rituximab were sufficient to normalize our patient. We present here a case of safe and effective use of rituximab in pregnancy-induced thrombotic thrombocytopenia.

Investigation of celiac disease followed by immune thrombocytopenic purpura diagnosis in patients and comparison with literature.

OBJECTIVE:Celiac disease (CD) and Immune thrombocytopenic purpura (ITP) may occur together as a result of similar autoimmune mechanisms. The aim of this study was to assess the frequency of CD in a group of ITP patients and in the literature.METHODS:A total of 29 patients in Pamukkale University Faculty of Medicine Hospital Pediatric Hematology and Oncology Department with ITP were included in the study. Test was performed for the antibodies related to CD. Positive result for celiac antibodies was confirmed with biopsy. The results were compared with the literature.RESULTS:Of the study group, 13 patients (44.8%) were female and 16 (55.2%) were male. The mean age was 7.2±4.7 years and mean platelet count at the time of admission was 13,440±11,110/mm3 (range: 2000-41,000/mm3). Twelve patients (41.4%) were diagnosed as acute ITP, 6 patients (20.7%) as persistent ITP, and 11 patients (37.9%) as chronic ITP, according to the duration of thrombocytopenia. Antibody positivity was detected in 1 patient. Histological evaluation was compatible with CD. Results were compared with studies regarding the prevalence of CD in the population. No significant difference was found.CONCLUSION:Although it is not necessary to perform CD test in every case of ITP, the presence of differential diagnosis of CD is important to prevent unnecessary treatment, especially in ITP patients with growth retardation or malabsorption findings.

Correlation of Notch1/Hes1 Genes Expression Levels in Egyptian Paediatric Patients with Newly Diagnosed and Persistent Primary Immune(Idiopathic) Thrombocytopenic Purpura.

Notch signalling is involved in the development of several autoimmune diseases, one of such diseases is ITP. The aim of this study was to investigate and compare the expression levels of Notch1 receptor and its target Hes1 gene in Egyptian paediatric ITP patients. Real-time quantitative reverse transcriptase polymerase chain reaction was used to analyse the expression levels of Notch1 and Hes1 in 42 children with primary ITP (22 newly diagnosed and 20 persistent) cases. Twenty age and sex matched non-ITP controls were included. The expression levels of Notch1 were higher in newly diagnosed and persistent cases than controls with high statistical significant difference (P value <0.001, P<0.001) respectively, similarly as regards the expression levels of HES1 (P value <0.001, P<0.007) respectively. A significant positive correlation was found between Notch1 and Hes1 expression levels in newly diagnosed cases (r=0.587, P value=0.004). There was an association between levels of both genes in most of ITP patients but Hes1 was markedly elevated than Notch1 in few cases. High expression levels of Notch1/Hes1 indicated the important role of Notch signalling in both newly diagnosed and persistent ITP. High expression levels of Hes1 than Notch1 may shed light on its value as a therapeutic target for future research in ITP.

Expression and significance of vitamin D and its receptor mRNA in the peripheral blood of initial immune thrombocytopenic patients

To investigate the effect of vitamin D in pathogenesis and clinical treatment of patients with immune thrombocytopenic (ITP), ELISA was used to detect the level of 25-hydroxylate vitamin D3[25(OH)D3] and 1,25-dihydroxyvitamin D3[1,25(OH)2D3] in peripheral blood from 45 ITP patients and 30 normal controls. Vitamin D receptor (VDR) mRNA expression was detected by RT-PCR. The results showed that the levels of 25(OH)D3 (10.6 ± 7.7 ng/ml) and 1,25(OH)2D3 (69.9 ± 29.0 pg/ml) in peripheral blood of the initial ITP patients were lower than those in peripheral blood of normal controls (13.7 ± 9.1 ng/ml, 87.3 ± 19.9 pg/ml) (P < 0.05). The expression of VDR gene obviously increased in peripheral blood of initial ITP patients (1.588 ± 0.127), as compared with that in peripheral blood of normal controls (1.055 ± 0.734) (P < 0.05). It is concluded that vitamin D level and its receptor expression may play an important role in ITP, and vitamin D and its similarities may be a new agent to treat patients with ITP.

Dose Adjustment and Use of Alternative Eltrombopag Dosing Regimens for the Treatment of Patients with Chronic Immune (Idiopathic) Thrombocytopenic Purpura (ITP)

Abstract 4657 Introduction:Recently, the therapeutic approach of patients with chronic refractory thrombocytopenic purpura has dramatically improved since the adoption, as second-line treatment, of two new thrombopoietin receptor agonists, Eltrombopag and Romiplostim.Purpose: Reporting the experience of our Center on the efficacy, dosing regimens and safety of the administration of Eltrombopag in refractory ITP patients.Material and Methods: We studied retrospectively 300 patients in our Center with a diagnosis of ITP. One hundred eighty five patients were classified as refractory ITP after multiple cycles of treatment. Fourteen patients with refractory ITP were treated with Eltrombopag during the last two years. We studied dose adjustment, the time to response and duration of response as well adverse events. A partial response (PR) was defined as achieving a platelet count of ≥ 50×103/ml, while a complete response (CR) as achieving a platelet count of ≥ 150 × 103/mL.Results: The patients were six men and eight women with a median age of 68.5 years (39.0 to 84.0 years). These patients had tried and failed numerous previous treatment regimens (2 to 8), including 6 patients who had received the thrombopoietin receptor agonist Romiplostim, 2 patients with splenectomy, as well as 2 patients in PR, who needed a higher platelet count due to concomitant disease. The median time from ITP diagnosis to Eltrombopag administration was 20.5 months (0.3 to 235.9 months) and the initial median platelet count was 34×103/mL. Twelve out of 14 patients (12/14 ) responded (85.71%), 10 CR (71.42%) and 2 PR (14.29%) with a mean platelet count of 294 × 103/mL (an increase of 260.5 x103/mL). The median time to response was 17 days (5–64 days) and the response was durable in 9/ 10 patients (90%). Forty per cent of patients required a dose increase at the Day 22 visit. The starting dose was 25mg once daily of Eltrombopag and administered over 6 cycles. If the patientxs platelet number was >200 x103/mL the treatment was interrupted. The next cycle started when the patient’s platelet count was <20 x103/mL. The dose of Eltrombopag was increased to 75mg daily when a patient’s platelet count remained < 50 x103/mL. The number of patients who had Eltrombopag dose increases to 75mg were 3 (21%), 2(14%) and 2 (14%) in cycles 1, 2 and 3, respectively. One patient (7%) experienced a serious side effect such as thromboembolic disease (right leg deep venous thrombosis and pulmonary embolism).Conclusions: Despite the small number of patients in this study, our results agree with those of similar large studies from other Centers. Since Eltrombopag is an oral therapy and does not require hospitalization, is an easy, effective, alternative therapy, which improves the quality of life of patients with refractory ITP. In most cases dose adjustment and use of alternative Eltrombopag dosing regimens is needed. Disclosures:No relevant conflicts of interest to declare.

W257 NEW-ONSET IMMUNE THROMBOCYTOPENIC PURPURA (ITP) IN PREGNANCY

W257 NEW-ONSET IMMUNE THROMBOCYTOPENIC PURPURA (ITP) IN PREGNANCY

Bone marrow reticulin and collagen content in patients with adult chronic immune thrombocytopenic purpura: A Danish nationwide study

We quantified and differentiated reticulin and collagen content in bone marrow specimens from chronic immune thrombocytopenic (ITP) patients and examined the correlation between some clinical characteristics and the fibrosis grading. Through the Danish National Patient Registry, we identified 378 patients with chronic ITP from 1997 until 2007. Of these, 253 (67%) had undergone at least one bone marrow biopsy, and we retrieved the bone marrow specimens from 187 (74%). We graded the bone marrow content of reticulin and collagen according to the Thiele scale (Grade 0-3). We also retrieved information on patients' clinical characteristics. We examined the prevalence of bone marrow fibrosis grading > 0 by patients' age (≤ 75 years and > 75 years), sex, platelet count at baseline (< 30 × 10⁹/L, and ≥ 30 × 10⁹/L), splenomegaly, hepatomegaly, and medications. In total 75 chronic ITP patients (40%) had a bone marrow grading >0. Of these, 72 (39%) had Grade 1 reticulin fibers present. Only three patients (< 2%) had collagen fibers present: two had Grade 2 and one had Grade 3. The prevalence of bone marrow grading > 0 was lower in patients aged > 75 years than ≤ 75 years (prevalence ratio = 0.64, 95% CI: 0.36-1.15) and lower in men than women (prevalence ratio = 0.70, 95% CI: 0.45-1.09), while a baseline platelet count ≥ 30 × 10⁹/L was associated with a higher prevalence of grading > 0 (prevalence ratio = 1.24, 95% CI: 0.81-1.86). Thus, bone marrow reticulin and collagen content in chronic ITP patients may be associated with some clinical characteristics.

A Randomized, Double-Blind, Placebo-Controlled Phase 1/2 Study to Determine the Safety and Efficacy of Romiplostim in Children with Chronic Immune (Idiopathic) Thrombocytopenic Purpura (ITP).

Abstract 680 Introduction: ITP is an autoimmune disorder characterized by thrombocytopenia due to accelerated destruction as well as suboptimal platelet production. Childhood ITP is most commonly an acute illness; however, chronic ITP (duration > 6 months) develops in 20%–30% of ITP cases. Romiplostim, a peptibody protein designed to increase platelet production, is approved for treating chronic ITP in adults. The objective of this study was to evaluate the safety and efficacy of romiplostim in the treatment of thrombocytopenia in children with chronic ITP. Patients and Methods: ITP patients aged 12 months to 20 × 109/L above baseline for 2 consecutive weeks without rescue therapy at any point during the treatment period). Treatment was initiated at 1 μg/kg once weekly by subcutaneous injection. The dose was adjusted in 2 μg/kg increments every two weeks, to a maximum dose of 10 μg/kg/week based on weekly platelet counts. The incidence of adverse events (AEs) during the 12-week treatment period and the number of patients achieving platelet counts >50 × 109/L for 2 consecutive weeks during the treatment period, or achieving an increase in platelet count >20 × 109/L above baseline for 2 consecutive weeks during the treatment period was recorded. Results: A total of 22 (romiplostim, 17; placebo, 5) patients were randomized; 16 (73%) were boys and 6 (27%) were girls. Eight patients had undergone splenectomy. The mean age was 9.5 (SD: 5.1) years, with 4 subjects aged 12 months - Conclusion: Treatment with romiplostim appeared to be well tolerated in pediatric ITP patients, with no new safety concerns observed in this study as compared to adults with chronic ITP. Romiplostim was effective in treating thrombocytopenia in children with chronic ITP. Disclosures: Buchanan:Amgen Inc.: Research Funding. Off Label Use: Use of romiplostim, a thrombopoietin mimetic, in treatment of thrombocytopenia in pediatric ITP patients. . Bomgaars:Novartis: Research Funding. Bussel:Eisai, Inc: Research Funding; Sysmex: Research Funding; Shionogi: Membership on an entity9s Board of Directors or advisory committees; Ligand: Membership on an entity9s Board of Directors or advisory committees, Research Funding; Immunomedics: Research Funding; Amgen: Equity Ownership, Membership on an entity9s Board of Directors or advisory committees, Research Funding; GlaxoSmithKline: Equity Ownership, Membership on an entity9s Board of Directors or advisory committees, Research Funding; Cangene: Research Funding; Genzyme: Research Funding; Scienta: Speakers Bureau. Nie:Amgen Inc.: Employment, Equity Ownership. Eisen:Amgen Inc.: Employment, Equity Ownership. Berger:Amgen Inc.: Employment, Equity Ownership.

Immune (Idiopathic) Thrombocytopenic Purpura (ITP): Treatment Pattern and Splenectomy Rate from a Multinational Prospective Observational Study

ITP is an autoimmune disease characterized by low platelet counts due to increased platelet destruction and inadequate platelet production. It is often a chronic disorder that requires long-term treatment. Current common treatment therapies for chronic ITP include corticosteroids, intravenous immunoglobulins (IVIG), rituximab, and anti-D antibody. Splenectomy may be required for those patients who do not respond or relapse after these medical therapies, or require intolerable doses to achieve safe platelet counts. Few studies have reported treatment pattern of current therapies for ITP. We report results of an international multi-center retrospective and prospective observational study of adult patients receiving treatments and/or splenectomy for chronic ITP. Patients with a diagnosis of ITP were enrolled from 100 community and academic centers. Date of 1st ITP diagnosis, treatments received and medical history were obtained retrospectively from patient chart data. ITP treatments, dose, response, and duration of response were collected prospectively for 12 months. Among 326 patients with ITP studied (mean age=54 years, male 40.2%), 24% received a splenectomy during this study. In patients who were not splenectomized (n=248), 77% received ITP medications with corticosteroids being the most frequently prescribed medication among patients who received 1 type of ITP treatment. IVIG was most frequently prescribed in patients who received 2 types of ITP treatments, and patients were most likely to receive a splenectomy after receiving 2 or more types of ITP treatments (table). In splenectomized patients, the average duration from ITP diagnosis to splenectomy was 2.79 years (n=74, SD=4.42, min=0, max=23.38). Prior to surgery, splenectomized patients were most likely to receive corticosteroids in patients receiving 1 type of treatment, and IVIG in patients receiving 2 types of ITP treatments. Following surgery, splenectomized patients were also most likely to receive corticosteroids in patients receiving 1 type of ITP medication, and rituximab in patients with 2 types of ITP medications. Overall, patients with ITP are exposed to numerous ITP treatments, among which, corticosteroids were most frequently used in both splenectomized and non-splenectomized patients. All patients receiving a splenectomy also required 1 or more ITP treatments following surgery. These results demonstrate that current ITP therapies are limited in efficacy and durability and often lead to patients receiving multiple types of ITP treatments. Novel ITP therapies with better efficacy and durable response are needed.Splenectomizedb(N=78)ITP Treatments ReceivedOverall (N=326)Pre-Splenectomy (N=74)Post-Splenectomy (N=74)Non-Splenectomized (N=248)058 (18)0058 (23)189 (27)23 (31)37 (50)83 (33)Exposure Rate n(%)282 (25)15 (20)17 (23)62 (25)349 (15)18 (24)11 (15)27 (11)4 or More48 (15)18 (24)9 (12)18 (7)1Corticosteroids (71%)Corticosteroids (57%)Corticosteroids (22%)Corticosteroids (76%)Most Frequently Used Therapy (%)a2IVIG (39%)IVIG (73%)Rituximab (24%)IVIG (52%)3Splenectomy (45%)IVIG (56%)IVIG (27%)IVIG (52%)4 or MoreSplenectomy (63%)Rituximab (11%)Vincristine (22%)Rituximab (78%)aMost frequently used treatment or therapy observed within that subgroup (receiving 1, 2, 3, 4 or more treatments). Percentages (%) are calculated as n divided by the total number of patients within the corresponding subgroup.b4 splenectomized patients were excluded from the analysis due to missing data.

Immune (idiopathic) thrombocytopenic purpura (ITP) treatment pattern and clinical efficacy

17529 Background: Immune (Idiopathic) Thrombocytopenic Purpura (ITP) is an autoimmune disorder characterized by persistent thrombocytopenia (peripheral blood platelet count <150 × 109/L). Few studies report efficacy of current therapies for ITP or resulting health-related quality of life (HRQoL). We present interim results of an international multi-center prospective observational study describing clinical efficacy of ITP treatments (trts). Methods: Patients (pts) with a diagnosis (dx) of ITP from community and academic centers were enrolled. Pts retrospective chart data provided date of 1st ITP dx, trts received and medical history. ITP trts, dose, response, and duration of response were collected prospectively for 12 months (mo). HRQoL was assessed with an ITP questionnaire (ITP-PAQ) where higher scores relate to better patient-reported outcomes. Results: Of the first 100 pts (43% male and mean age 70 years), 24 received a splenectomy and 74 received ITP-related trts. Among the 74 pts, corticosteroids (N=61), intravenous immunoglobulins (IVIG) (N=36), rituximab (N=27), and anti-D antibody (N=22) were the most frequently used. On average, pts received 2 to 3 types of ITP trts during the study period (median person years=2.97) with corticosteroids usually as 1st line of treatment. Median duration of response was 8 mo for rituximab, 10 mo for corticosteroids, 15 mo for IVIG and 17 mo for anti-D antibody. Hospitalizations per person year ranged from 0 (rituximab) to 0.8 (IVIG). ITP-PAQ scores significantly decreased in pts on corticosteroids (p<0.05), compared to other trt groups where ITP-PAQ scores increased. Conclusions: Efficacy of all ITP trts was limited in duration and pts receiving corticosteroids had significantly decreased HRQoL. Further studies are needed to assess the long-term impact of ITP trts on patient outcomes, health resource utilization, and downstream costs. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Expert Testimony Other Remuneration Amgen, Inc. Amgen, Inc. Amgen, Inc.

CLINICAL FEATURES AND TREATMENT OUTCOMES OF INFANTS WITH IMMUNE THROMBOCYTOPENIC PURPURA

CLINICAL FEATURES AND TREATMENT OUTCOMES OF INFANTS WITH IMMUNE THROMBOCYTOPENIC PURPURA

Effect of Peg‐Interferon, Ribavirin and Danazol on experimental fibrosis induced in rats

The current standard therapy of patients with chronic hepatitis C is the combination of peg-interferon (IFN)-α and ribavirin.However, it is well known that interferon in combination with ribavirin treatment may exacerbate the neutropenia and thrombocytopenia in those patients. Danazol therapy seems to be a useful and well-tolerated treatment for refractory immune thrombocytopenic associated with several autoimmune diseases. The aim of this work was to investigate whether the simultaneous administration of peg-interferon, ribavirin and danazol mofify the liver fibrosis. Male Wistar were included in: Control; Danazol (0.166mg/day); IFN (1.2μg/week) + Ribavirina (1 mg/day); IFN + Rib + Dan; CCl4 (0.4 g/kg/ 8 weeks); CCl4 + IFN + Rib; CCl4 + IFN + Rib + Dan. At the end of treatment we analyzed liver function and morphology, collagen content, and the mRNA for TGF-beta1, TNF-alpha, PDGF e interleukins (1, 6 and 10). Our results showed that the combined treatment with peg-interferon, ribavirin and danazol improved the liver function and architecture. It was reduced the total amount of collagen which correlated with the collagen bands in liver tissue. The treatment with peg-interferon, ribavirin and danazol induce a change in the patron of expression of pro-imflamatory and anti-inflamatory cytokines. Therefore the combine treatment with treatment with peg-interferon, ribavirin and danazol appear to be a new terapeutic option in those patients with chronic hepatitis C virus infection.

IMMUNE THROMBOCYTOPENIC PURPURA IN CHILDHOOD IN NORWAY: A Prospective, Population-Based Registration

A prospective, population-based registration of children with immune thrombocytopenic purpura (ITP) was performed in Norway in 1996 and 1997. Ninety-two cases were identified, indicating an incidence of 5.3 per 100,000 children under 15 years. The sex ratio (female/male) was 1.2/1. Fifty six percent presented with cutaneous signs only. The lowest platelet count was < 20x109

HIGH-DOSE INTRAVENOUS METHYLPREDNISOLONE FOR IMMUNE THROMBOCYTOPENIC PURPURA

HIGH-DOSE INTRAVENOUS METHYLPREDNISOLONE FOR IMMUNE THROMBOCYTOPENIC PURPURA