Onset Of Idiopathic Thrombocytopenic Purpura Research Articles

A 5-month patient with ITP secondary to SARS-CoV-2

Idiopathic thrombocytopenic purpura (ITP) is a hematological disease characterized by the immune-mediated destruction of platelets. It either resolves or becomes chronic. Before the onset of ITP, many children have an antecedent viral illness, which can be an upper respiratory infection or gastroenteritis. Regarding ITP frequency, infancy is the least prevalent age group when compared to older children. In this case report, we present the first infantile case of ITP associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that was successfully treated with intravenous immunoglobulin (IVIg).

The Influence of Primary Cytomegalovirus or Epstein-Barr Virus Infection on the Course of Idiopathic Thrombocytopenic Purpura.

Idiopathic thrombocytopenic purpura (ITP) in children is usually triggered by a viral infections such as cytomegalovirus (CMV) or Epstein-Barr virus (EBV) infection. The aim of this study was to assess the frequency of CMV and EBV infections in children with first relapse of ITP, and the influence of these infections on the course and response to treatment of ITP. Sixty patients (30 boys and 30 girls) with ITP were enrolled into the study. We found that the age at the onset of ITP was from 1 month to 17 years (mean 7.0 ± 5.7 years), the platelet number was from 1 to 79 x 10(9)/L (mean 18.1 ± 19.0 x 10(9)/L) at the time of diagnosis and it increased from 17 to 395 x 10(9)/L (mean 134.4 ± 81.2 x 10(9)/L)(p < 0.05) after the first course of therapy. Forty seven patients required pharmacological treatment, the duration of the treatment was from 2 to 25 days (mean 6.1 ± 4.1 days). Relapses were observed in 27 (45%) of the patients. Active CMV infection was found in 19 patients (31.7%), EBV infection in 5 patients (8.3%), and both infections concomitantly in 1 patient (1.7%). The group of patients with CMV or EBV infection(n = 25) did not differ from the patients free of infection (n = 35) in regard to the age, number of platelets at onset, duration of treatment, number of platelets after treatment, number of relapses, and the interval between the onset and first relapse. In conclusion, active CMV or EBV infection is common in children with ITP. These infections do not seem to have an appreciable bearing on the clinical course and the response to treatment on children with ITP.

Helicobacter pylori infection in Mongolian gerbils does not initiate hematological diseases.

To investigate whether Helicobacter pylori (H. pylori) infection contributes to idiopathic thrombocytopenic purpura (ITP) or iron-deficiency anemia (IDA) onset in gerbils. A total of 135 Mongolian gerbils were randomly divided into two groups: an H. pylori infection group and a control group. Both groups were fed the same diet and the same amount of food. Each group was then divided into three subgroups, which were sacrificed at 6, 12, or 18 mo for analysis. At each time point, arterial blood was collected from the abdominal aorta and a complete blood cell count was analyzed in the clinical laboratory in the First Affiliated Hospital of Nanchang University. There were no significant differences in platelet counts (938.00 ± 270.27/L vs 962.95 ± 162.56 × 10(9)/L), red blood cell counts (8.11 ± 1.25/L vs 8.44 ± 1.48 × 10(12)/L), or hemoglobin levels (136.9 ± 8.76 g/L vs 123.21 ± 18.42 g/L) between the control and the H. pylori groups, respectively, at 18 mo. With the exception of the mean corpuscular volume (MCV), all other indicators, including white blood cell counts, hematocrit, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, red blood cell distribution width, mean platelet volume, platelet distribution width, lymphocyte count, and lymphocyte count percentage, showed no significant differences between the control and H. pylori infection groups at each time point. The MCV in the H. pylori infection group (52.32 f/L ± 2.86 f/L) was significantly lower than the control group (55.63 ± 1.89 f/L) at 18 mo (P = 0.005), though no significant differences were observed at 6 (54.40 ± 2.44 f/L vs 53.30 ± 1.86 f/L) or 12 mo (53.73 ± 2.31 f/L vs 54.80 ± 3.34 f/L). A single H. pylori infection is insufficient to cause onset of ITP or IDA and other factors may be required for disease onset.

Role of CD4 +CD25 + T Cells in Children With Idiopathic Thrombocytopenic Purpura

CD4CD25 T cells play an important role in the induction and maintenance of peripheral self-tolerance. These professional regulatory cells prevent the activation and proliferation of potentially autoreactive T cells that have escaped thymic deletion. To investigate the role of CD4CD25 regulatory T cells in children with idiopathic thrombocytopenic purpura (ITP) and correlate their levels with different disease stages, this study was conducted in 45 children (15 controls and 30 cases with ITP); 10 of these patients were in the acute phase (Group I), 10 in the remission phase (Group II), and the remaining 10 in the chronic phase (Group III). Studied groups were subjected to the following investigations: complete blood count, erythrocyte sedimentation rate, Coombs test, and flow cytometric analysis of CD4CD25 T lymphocyte count. There was a highly significant decrease in platelet count and CD4CD25 count in patients of the acute group when compared with remission, chronic, and control groups. There was a significant decrease in CD4CD25 count in the chronic group when compared with remission group. In addition, a significant decrease in CD4CD25 count was found in remission group when compared with the control group. Moreover, there was a positive correlation between CD4CD25 count and platelet count in all the groups; this correlation was significant in the acute group and insignificant in the remission and chronic groups. Decreased number of CD4CD25 T cells might be one of the mechanisms that cause immune regulation dysfunction in ITP and the count of CD4CD25 T cells is considered to be related to the severity of ITP, as these cells were significantly decreased in the active phase of the disease and increased in the patients at the complete remission phase. Therefore, count of CD4CD25 T cells might be a helpful diagnostic predictor of onset and improvement of ITP in children. Finally, it is suggested that these cells may have therapeutic implications that need further clarification.

Alteration in serum B cell‐activating factor levels inpatients with idiopathic thrombocytopenic purpura after Helicobacter pylori eradication therapy

Alteration in serum B cell‐activating factor levels inpatients with idiopathic thrombocytopenic purpura after <i>Helicobacter pylori</i> eradication therapy

Acute idiopathic thrombocytopenic purpura in an elderly adult: a case study

The paper is a case study of an 81-year-old female with an acute onset of idiopathic thrombocytopenic purpura (ITP). This diagnosis is rare in adults, and this article discusses the patient's clinical presentation and a review of ITP.

Subcutaneous Anti-D as Treatment of Idiopathic Thrombocytopenic Purpura in Children; Clinical Observations.

Treatment options for patients suffering from idiopathic thrombocytopenic purpura (ITP) mostly involve intravenous IgG (IVIG) or intravenous anti-D. Subcutaneous (s.c.) anti-D may be an attractive alternative; easy to administer and with less side effects. We present the clinical experience from treating six children suffering from ITP with s.c. anti-D.Five of the six patients had chronic ITP. One patient (patient number 3) had acute ITP. All patients with chronic ITP had been treated with IVIG prior to s.c. anti-D treatment, but not within four weeks before. Platelet counts (PLT) increased after all IVIG treatments, but for patient number 1 and 2 the increase was limited with repeated courses. Patient number 4 had also been treated with steroid with no effect.The number of anti-D treatments varied from 1–12. Only patient number 2 received 12 treatments. Doses were 50μg/kg or 75μg/kg anti-D. When treated, all patients had cutaneous bleeding. In patient number 1, episodes with epistaxis and gum bleeding also occurred.After s.c. anti-D cutaneous bleeding manifestations were reduced in five patients. In patient number 3 symptoms remained unchanged after the second treatment. Patient number 4 had no detectable clinical effect of the s.c anti-D.The effect on PLT varied greatly (table 1). Repeated increases in PLT to above 20•109/L were achieved in patient number 1. After the first treatment of patient number 2, PLT increased from 10•109/L to 37•109/L associated with a marked reduction in petechiae and bruising. In patient number 3 PLT increased only after the first treatment from 10•109/L to 67•109/L.Time till relapse also varied. Relapse is here defined as; the first day after treatment where PLT was continuously below 10*109/L for two weeks or more. For patient number 1 time till relapse after treatment increased. In patient number 2 bleeding tendency was reduced with regular treatments. Therefore, he was treated every four weeks for six months, and received, in total, 12 treatments over a 32 months period. Patient number 5 was treated twice. After the last treatment PLT has remained stable. Soreness and minor bruising at injection site were reported side effects.The average decrease in hemoglobin (Hgb) was 0.77 g/dL (range 0–2.4 g/dL). Lactate dehydrogenase (LDH) was not measured for all patients after every treatment, but the results available (table 1) indicated no or only minor degree of hemolysis. Patient number 3 reported dark morning urine 10 days after the second treatment. Dip-slide showed no hematuria. His Hgb was 11.0 g/dL and had decreased 0.5 g/ dL. LDH was not measured.Subcutaneous anti-D treatment was clinical effective with few side effects in five of six patients. Four of the five patients had been treated with IVIG prior to s.c. anti-D. Subcutaneous anti-D may be an attractive therapy, and the effect is under further investigation in a multi center trial.Demographic and paraclinical dataPatient numberSexAge at onset of ITP (Years)S.C. Anti-DDuration of ITP at treatment (months)PLT (start/end) [•109/L]Relapse (day after treatment)LDH (before →after) [U/I]1M3192–4 / 58–33456–125(no control)2M2176–16 / (no control)(no control)571→7323M1003- 10 / 7–6778*502→5234M4671 / 7n/a230→2275F497–19/ 67–93n/a240→2576F7103 / 6222292→321* After first treatment

Factors predicting development of chronic disease in Nordic children with acute onset of idiopathic thrombocytopenic purpura

Factors predicting development of chronic disease in Nordic children with acute onset of idiopathic thrombocytopenic purpura

IDIOPATHIC THROMBOCYTOPENIC PURPURA AND HELICOBACTER PYLORI INFECTION

Introduction: It has recently been reported that a relationship between Idiopathic Thrombocytopenic Purpura (ITP) and Helicobacter Pylori (HP) infection exists in adult series. A link between the eradication of the infection itself and the remission of thrombocytopenia has also been observed. The aim of our study was to assess the prevalence of HP infection in children affected by chronic ITP and to verify the influence of the treatment on platelets counts. Patients and Methods: Our study lasted a minimum of 12 months and involved 31 children (Mean age: 136 months; range: 53-216 months; M/F: 10/20), all affected by chronic ITP. Patients were followed for 12 months: 6 months to assess chronic behaviour of ITP and 6 months for the follow-up. Unsplenectomized patients affected by chronic ITP underwent: Urea Breath Test (UBT), a search for HP antigen in stool samples as well as a search for HP antibodies in serum. In order for a diagnosis of HP infection to be made, two of the 3 results in the above mentioned tests had to be positive. Patients affected by HP infection were randomized into two groups: one group was treated with amoxicilline, claritromicine and omeprazole; the second group did not receive any therapy: Six weeks after the end of treatment patients underwent a UBT to assess their recovery from HP infection. In both groups, treated and untreated, for the 6 months following the diagnosis of chronic ITP, platelet counts were performed weekly (for Platelets <20000/mmcu), every 2-3 weeks (for Platelets between 20000 and 50000/mmcu) and monthly (for Platelets >50000/mmcu). Results: In our study the prevalence of HP infection in patients affected by chronic ITP was 22.5% (7/31 patients). Three of 7 patients were treated (Mean age: 174 months), and the mean platelet count at the onset of ITP was 72000/ mmcu (range 33000-128000/mmcu); 1/3 patients who received treatment did not recover from HP infection. In the 4 untreated patients (Mean age: 143 months) the mean platelet count was 94000/mmcu (range: 63000-124000/mmcu). At the follow-up the platelet count difference between treated and untreated patients and between infected and uninfected patients was not statistically significant. Conclusions: Our preliminary data do not suggest any relationship between ITP and HP infection.

Characteristics of Helicobacter pylori-induced gastritis and the effect of H. pylori eradication in patients with chronic idiopathic thrombocytopenic purpura.

The association between Helicobacter pylori infection and idiopathic thrombocytopenic purpura (ITP) has been reported widely. We investigated the prevalence of H. pylori infection, its virulence profile and the effectiveness of its eradication in patients with ITP. Twenty patients with ITP, 20 with peptic ulcer (10 gastric ulcer (GU), 10 duodenal ulcer (DU)) and 20 with NUD were studied. The virulence profile of the strains was assessed by genotyping for cagA, vacA, iceA, and hpyIIIR/hrgA and by assaying for IL-8 and DNA fragmentation after incubation with AGS cells. Infected patients and two uninfected ITP patients received triple therapy and platelets were counted before and 1 month, 6 months, 1 year, and 2 years after eradication therapy. H. pylori infection was found in 17 ITP (85%), 20 ulcer (100%) and 13 NUD (65%) patients. Biopsies and strains were collected from five ITP, 20 ulcer and 13 NUD patients. The ITP patients had a pangastritis or corpus-predominant gastritis pattern. All H. pylori isolates, from ITP, ulcer and NUD patients, were cagA(+) and vacA s1/m1, and did not differ in levels of IL-8 induction or DNA fragmentation. Fifteen ITP (88%) and 17 ulcer (85%) patients had successful eradication of H. pylori. Ten of these 15 (67%) H. pylori-eradicated ITP patients had platelet recovery. There was no significant change in platelet count in the two ITP patients in whom eradication failed or in the two originally H. pylori-uninfected ITP patients, or in the treated ulcer patients. Age at onset of ITP was the main determinant of platelet recovery: 100% of patients diagnosed after the age of 60 recovered compared with only 22% of those diagnosed before 50. H. pylori-infected ITP patients have a corpus-predominant pattern of gastritis but the virulence profile of their strains does not differ from that of ulcer or NUD patients. Eradication of H. pylori infection is a good therapeutic option for some patients with chronic ITP, especially for those who develop ITP in older age.

Seventeen years of experience with chronic idiopathic thrombocytopenic purpura in childhood. Is therapy always better?

Between 1975 and 1992 450 children with idiopathic thrombocytopenic purpura (ITP) were diagnosed, and of those 100 (22%) developed the chronic form of the disease. Approximately half the patients with chronic ITP presented with mild to moderate hemorrhagic manifestations at the onset of purpura (30 cases) and/or later during the course of the disease (25 cases). The incidence of intracranial hemorrhage was 1%, and the mortality rate due to overwhelming septicemia after splenectomy was also 1%. Overall one-third of the patients received no therapy; two-thirds of them went into spontaneous remission within 8 months to 8 years from the onset of ITP. Steroids given in conventional or high doses (51 cases) achieved a transient (if any) rise in platelet count, but in no case were steroids curative. Remission related to intravenous immune globulin (IVIG) therapy was noticed in 38.5% of the children (10 of 26) after variable courses. The response rate to splenectomy was 95.0%. Ultimately the long-term outcome in children with chronic ITP was as follows: remission, 58 cases (spontaneous, 30; after IVIG therapy, 10; after splenectomy, 18); hemostatic platelet values, 22 cases (spontaneous, 16; after IVIG, 5; after splenectomy, 1). Thirteen children were lost in follow-up, and 7 remain thrombocytopenic but asymptomatic. These data indicate that chronic ITP in childhood runs a benign course in most cases and may remit with or without therapy even several years from onset. Therefore, therapeutic intervention has to be individualized, and splenectomy, which is not always safe, should be reserved for problematic cases that fail to respond to conventional therapeutic modalities.

Childhood Idiopathic Thrombocytopenic Purpura: Experience at King Khalid University Hospital, Riyadh

Forty-nine children (30 boys and 19 girls) with idiopathic thrombocytopenic purpura (ITP) seen at King Khalid University Hospital (KKUH) Riyadh, during a 7-1/2 year period were retrospectively reviewed with regard to their clinical characteristics, management, and outcome. The age of onset of the disease ranged from 8 months to 11 years with a mean of 4.26 years. Twenty-seven cases presented as acute ITP while 22 cases presented as chronic ITP. The clinicopathological features and response to treatment of the cases were essentially similar to findings in other parts of the world. In a search for a predictor of chronic disease, the platelet counts at four weeks and three months after diagnosis were found to be a significant factor for prediction of chronicity of ITP. If the platelet counts are less than 100x10(9)/L during these periods, the risk of chronic ITP is increased and vice versa. There was, however, no correlation in our patients between duration of symptoms prior to presentation and outcome of the disease as has been reported by investigators in Europe and Australia.

A Novel Anti-ENA Antibody in Sera of Patients with Childhood Idiopathic Thrombocytopenic Purpura

Circulating antibodies against certain extractable nuclear antigens (ENA) have been shown to have diagnostic and prognostic importance in connective tissue diseases. We described here an antibody against ENA found in the sera of patients with idiopathic thrombocytopenic purpura (ITP). The antigen, tentatively called WK according to the patients' initials, was distinct from U1 RNP/Sm, SSA/SSB, Scl-70, PCNA, PM-Scl, Jo-1, and Ku by immunodiffusion. On immunoblotting, the anti-WK serum recognized polypeptides of 99 kd, 98 kd, and 96 kd in rabbit thymus extracts and a 99 kd polypeptide in KB cell extracts. The anti-WK antibody was detected in the sera of 2 out of 360 ANA positive patients, both children with clinical features of ITP. One patient developed systemic lupus erythematosus eight years after the onset of ITP.

Therapeutic experience on 934 adults with idiopathic thrombocytopenic purpura: Multicentric Trial of the Cooperative Latin American group on Hemostasis and Thrombosis

In order to analyze the usefulness of different types of treatment in relation to the interval since the onset of idiopathic thrombocytopenic purpura (ITP), a collaborative study of 934 adult patients was undertaken. Prednisone was administered to 818 patients, and 32% of them achieved prolonged complete remission (PCR). However, only 14% of patients who had ITP for more than six months achieved a prednisone- induced PCR (P less than .01). Splenectomy was done in 399 patients, and 65% of them achieved PCR; the remission rate did not vary with the interval since the onset of ITP. Of 120 patients with chronic ITP that was refractory to corticosteroids and splenectomy, 91 received either azathioprine or cyclophosphamide; 21% of them achieved PCR and 55% had a favorable response. None of 19 patients treated with vincristine and only one of ten patients treated with vinblastine-loaded platelets achieved PCR.

Therapeutic Experience on 934 Adults With Idiopathic Thrombocytopenic Purpura: Multicentric Trial of the Cooperative Latin American Group on Hemostasis and Thrombosis

AbstractIn order to analyze the usefulness of different types of treatment in relation to the interval since the onset of idiopathic thrombocytopenic purpura (ITP), a collaborative study of 934 adult patients was undertaken. Prednisone was administered to 818 patients, and 32% of them achieved prolonged complete remission (PCR). However, only 14% of patients who had ITP for more than six months achieved a prednisone-induced PCR (P < .01). Splenectomy was done in 399 patients, and 65% of them achieved PCR; the remission rate did not vary with the interval since the onset of ITP. Of 120 patients with chronic ITP that was refractory to corticosteroids and splenectomy, 91 received either azathioprine or cyclophosphamide; 21% of them achieved PCR and 55% had a favorable response. None of 19 patients treated with vincristine and only one of ten patients treated with vinblastine-loaded platelets achieved PCR.

Pregnancy complicated by idiopathic thrombocytopenic purpura

SummaryThe findings on 30 women with 48 pregnancies complicated by idiopathic thrombocytopenic purpura (ITP) have been analysed. The criteria for advising whether or not pregnancy complicated by ITP should be allowed to continue are as follows. When the onset of ITP precedes pregnancy and pregnancy occurs without any remission, termination of the pregnancy should be considered because in these circumstances ITP commonly runs a poor course. When the onset of ITP has preceded pregnancy, and is in remission at the time of conception, pregnancy can be continued. In those cases where ITP develops during pregnancy, it is generally possible to continue pregnancy.Haemorrhage during pregnancy can be controlled with corticosteroids and blood transfusion. In those cases with decreased platelet counts, bleeding from the uterine cavity after labour is not a problem but haemorrhage from lacerated wounds is difficult to control. Therefore, vaginal delivery is preferred unless there is an absolute indication for caesarea...

Idiopathic thrombocytopenic purpura in lymphoma

Five patients with idiopathic thrombocytopenic purpura (ITP) associated with malignant lymphoma are presented, and twelve other cases reported in the literature are reviewed. Thirteen patients (76%) had Hodgkin's disease; two had diffuse histiocytic, one, diffuse mixed lymphoma. Idiopathic thrombocytopenic purpura presented as the sole clinical manifestation of initial or recurrent lymphoma in 10 of 15 cases (67%). The spleen was not palpable even in patients who showed involvement with lymphoma at splenectomy. Three patients were asplenic at the onset of idiopathic thrombocytopenic purpura. Successful therapy of the thrombocytopenia correlated with effective control of the underlying lymphoma. Splenectomy gave favorable results in 9 of 10 cases (90%) and uncovered occult lymphoma in five patients. Chemotherapeutic drugs were successful in seven of 12 trials (58%) and only when the underlying disease was also controlled. The overall prognosis was related to the status of the lymphoma and was not altered by the occurrence of the idiopathic thrombocytopenic purpura.