Pediatric Immune Thrombocytopenic Purpura Research Articles

Impact of Helicobacter pylori Infection upon the Evolution and Outcome of Pediatric Immune Thrombocytopenic Purpura: A Comprehensive Review.

In adults with immune thrombocytopenic purpura (ITP), the identification of H. pylori infection and its subsequent eradication proved to aid platelet recovery. Similar findings, at a smaller scale, were allegedly reported by some pediatric studies. This review's objective was to establish the influence of H. pylori infection and its eradication upon platelet count and recovery in pediatric ITP. Three databases, namely Pubmed, Scopus and Web of Science, were searched for pediatric studies which investigated a link between H. pylori infection and thrombocytopenia. The search results retrieved a number of 21 articles which complied to the inclusion and exclusion criteria. Some studies report lower platelet values among children with ITP and documented H. pylori infection, as well as an improve in platelet numbers after H. pylori treatment. However, results are controversial, as multiple authors failed to identify a higher prevalence of H. pylori among children with ITP or a lack of significant change in therapeutic outcome with the addition of an eradication regimen to standard treatment. The main limitations of current pediatric studies remain the small study samples and the short follow-up periods of the included subjects. Hence, the long-term impact of H. pylori in children with ITP is still uncertain.

Role of Long non Coding RNAs, NEAT1 and Lnc-DC Expression in Pediatric Immune Thrombocytopenic Purpura.

Pediatric immune thrombocytopenic purpura (ITP) is an autoimmune disease; whose etiology is unknown. lncRNAs are regulators of numerous actions, which participate in the development of autoimmune diseases. We evaluated the expression ofNEAT1 and Lnc-RNA in dendritic cell (Lnc-DC) in pediatric ITP. Sixty ITP patients and 60 healthy subjects were enrolled in the present study; Real-time PCR was performed to assess the expression levels of NEAT1 and Lnc-DC in sera of children with ITP as well as healthy children. Both lncRNAs, NEAT1 and Lnc-DC were significantly upregulated in ITP patients in comparison to controls (p <0.0001 and P= 0.001 respectively). Furthermore, significant upregulation of the expression levels of NEAT1 and Lnc-DC were observed in the non-chronic compared with chronic ITP patients. Also, there was significant negative correlation between each of NEAT1 and Lnc-DC and platelet counts before treatment (r= -0.38; P= 0.003 and r= -0.461; P< 0.0001, respectively). serum lncRNAs, NEAT1 and Lnc-DC could be used as potential biomarkers in differentiating childhood ITP patients and healthy controls in addition to differentiating non-chronic from chronic ITP which may provide a theoretical basis for the mechanism and treatment of immune thrombocytopenia.

Immunological markers changes in pediatric immune Thrombocytopenic Purpura

Background Individuals with immune thrombocytopenic purpura (ITP) have cellular immune responses that show the characteristics of tolerance mechanisms that have broken down. Objectives This study aimed to assess the percentage of regulatory T cells (Tregs) and CD4 lymphocytes that express CXCR6 in untreated newly diagnosed ITP in pediatric patients and their correlation with each other, the platelet (PLT) count and other PLT indices. Patients and methods A case–control study was carried out that included 40 pediatric patients with ITP, and 20 age-matched and sex-matched healthy controls were selected from Benha Children Hospital hematology clinic. Assessment of CD4+, CD25+, and FoxP3+as markers of Treg cells and also expression of the CXCR6 receptor on CD4+ T lymphocytes to evaluate the percentage of Tregs and CD4/CXCR6 +T lymphocytes were investigated by flow cytometry. Results There was a marked reduction in CD4/CXCR6 and Tregs (P=0.02 and 0.001) in the ITP group versus the control group. In contrast, there was a marked increase in CD4/CD25+cells (P=0.002) in the ITP group compared with the control group. There was a considerable reduction in the PLT count and the hemoglobin concentration in the ITP group compared with the control group (P=0.000 and 0.01), while there was a significant increase in large platelet cell ratio and platelet distribution width in the ITP group in comparison to the control group (P=0.04 for both of them); also, there were insignificant differences in total leukocytic count and mean platelet volume in the ITP group in comparison to the control group (P=0.28 and 0.77). Conclusion There was a significant decrease in the concentration of CD4+ cells that express CXCR6+ and Treg percentage in ITP patients as compared with the controls, which may explain the defect in immune self-tolerance in ITP patients.

Assessment of plasmablast cells in immune thrombocytopenic purpura in children

Primary immune thrombocytopenic purpura (ITP) is an autoimmune disorder with platelet destruction due to B- and T-cell dysregulation and antiplatelet autoantibodies production. Flow cytometry can be used to further characterize the B- and T-cell compartments involved in platelet destruction. This case-control study was to enumerate plasmablast cells in pediatric ITP patients and to correlate their levels with disease course. This study included 30 ITP patients and 10 controls. Identification and enumeration of Plasmablast were done by multicolor flow cytometry using specific antibody panels (CD19, CD27 & CD38) and sequential gating using FACSCanto flow cytometer and FlowJo software. We found that lymphocytes subpopulation in ITP patients and controls revealed increase in frequency of CD19 (B lymphocytes) in acute, persistent, and chronic ITP patients in comparison with controls (p < 0.001, 0.023, 0.001) respectively. Plasmablast cells could play a role in the pathogenesis of ITP and might guide therapy in ITP patients in the future.

THE OUTCOME OF IMMUNE THROMBOCYTOPENIC PURPURA IN CHILDHOOD AND THE RISK FACTORS FOR CHRONICITY

Immune thrombocytopenic purpura (ITP) is the most common cause of pediatric thrombocytopenia. It is usually a self-limiting disease; however, 20-30% of cases become chronic. In this study, we aimed to investigate pediatric ITP cases’ outcomes and whether there are any factors affecting chronicity. We analyzed retrospectively our 184 newly diagnosed pediatric ITP cases. Thrombocytopenia was defined as chronic ITP if it persists after 12 months. We evaluated the role of clinical and laboratory findings of patients and treatment modalities in the chronicity of ITP. The mean age of patients was 5.4 ± 4.75 years at diagnosis. As first-line treatment, 87 (47.3%) of patients were given Intravenous Immune Globulin, 65 (35.3%) of patients were given methylprednisolone, and 32 (17.4%) of patients were followed without any medication. Chronic ITP developed in 39 patients (21.1%). Chronic ITP development rate was 20.19% in boys and 22.5% in girls (p=0.7). While the chronicity rate was 7.02% in children younger than two years old and 17.81% in children between 2 and 6 years, it was 42.59% in children older than six years old (p<0.0001). Mean hemoglobin and absolute lymphocyte count were significantly lower in chronic ITP patients in the 2-6 years age group. (p=0.014 and p=0.048, respectively). The first-line treatment choice had no important effect on chronicity (p=0.61). Our results suggest that the most critical factor in developing chronic ITP was the age at diagnosis. Low lymphocyte counts at diagnosis may be associated with a high chronicity ratio.

Neutropenia following intravenous immunoglobulin therapy in adult patients with immune thrombocytopenic purpura: A single center experience and literature review.

The purpose of this study was to evaluate neutropenia following intravenous immunoglobulin (IVIG) therapy in adults with immune thrombocytopenic purpura (ITP).Our analysis included 88 patients with ITP, who received IVIG from January 2006 to March 2016, at Pusan National University Hospital in Korea. Their white blood cell (WBC) count and absolute neutrophil count (ANC) before and after IVIG treatment were analyzed.Of 88 patients, 24 patients (27.3%) were male, and 64 patients (72.7%) were female. Neutropenia developed in 8 patients (18.7%) after IVIG treatment. In patients with a decrease in WBC count and ANC compared to baseline, median WBC count decreased from 6280/μL to 4530/μL after IVIG therapy, and median ANC decreased from 3840/μL to 2840/μL after IVIG therapy. The neutropenia induced by IVIG had resolved spontaneously after several days, and the mean recovery time was 8.72 days after the completion of the IVIG treatment. During the neutropenic episodes, only one patient developed neutropenic fever, which subsided soon without any treatment.The results of this study suggest that IVIG may cause neutropenia commonly in adults with ITP, and it seems to be transient and self-limited. This study is meaningful as the first report that not only pediatric ITP patients may develop neutropenia post IVIG administration, but also adult patients suffering ITP.

Routine funduscopy in immune thrombocytopenic purpura-is it really necessary?

Immune thrombocytopenic purpura (ITP) is a common cause of symptomatic thrombocytopenia in children, most of whom present with cutaneous and mucosal bleeding. Complications, such as intracranial hemorrhage and occult hemorrhage from various sites, are rare, and retinal hemorrhage is exceptionally rare. Our institutional clinical practice guidelines for managing ITP in the pediatric emergency department (PED) include routine funduscopy. The aim of this retrospective case series is to provide evidence-based recommendations for a tertiary care PED work-up of ITP, with special emphasis on the guidelines for funduscopy. The medical records of all pediatric patients diagnosed with ITP over a 4-year period (2013-2016) who had a platelet count < 50,000/mm3 were retrieved and reviewed. Seventy-five patients with thrombocytopenia (platelet count < 50,000/mm3) were diagnosed as having ITP in the PED. Sixty-one (79%) of these patients underwent funduscopy and retinal hemorrhage was ruled out in all of them, indicating that retinal hemorrhage as a complication of ITP is very rare.Conclusion: Our data suggest that funduscopy should not be performed routinely on pediatric ITP patients, but rather be reserved for those who present with concurrent anemia or visual complaints. What is Known: • Many internal institutional protocols in Israel call for retinal hemorrhage bleeding surveillance in work up of ITP. Our study found no case of ITP with retinal bleeding. What is New: • Many internal institutional protocols in Israel call for retinal hemorrhage bleeding surveillance in work up of ITP. Our study found no case of ITP with retinal bleeding.

Predictive factors of response to IVIG in pediatric immune thrombocytopenic purpura.

Immune thrombocytopenic purpura (ITP) is commonly treated with i.v. immunoglobulin (IVIG). We retrospectively evaluated whether pretreatment clinical and laboratory finding could predict the short- and long-term response to IVIG. Short-term response was estimated by platelet count 2weeks after IVIG, and long-term response was assessed on thrombocytopenia-free survival (TFS). TFS was defined as the probability of survival without treatment failure after initial IVIG, such as relapse, requirement for additional therapeutic interventions, or progressing to chronic ITP. Seventy-six patients with newly diagnosed ITP who were initially treated with IVIG were evaluated. Fifty-three patients (69.7%) were determined as responders at 2weeks after IVIG. On multivariate analysis, age ≥23months (P = 0.020) and platelet count <9.0×109 /L (P = 0.018) were considered to be unfavorable factors for short-term response. Cumulative proportion of long-term (1year) good prognosis was estimated at 53.0% (95%CI: 40.8-65.2). On multivariate analysis of unfavorable factors for long-term response, age ≥23months (P = 0.020) was the only significant factor. For new-onset ITP in patients aged >2years, corticosteroid therapy in addition to IVIG may be considered as the initial treatment.

Platelet indices as a diagnostic tool in pediatric immune thrombocytopenic purpura

Background Bone marrow examination is the gold-standard test in discriminating between hyperdestructive thrombocytopenia and hypoproductive thrombocytopenia. However, this procedure is invasive. Mean platelet volume (MPV) and platelet distribution width (PDW) are simple, inexpensive, and noninvasive methods that may be used in discriminating between these two types of thrombocytopenia. Aim This study investigated the significance of the platelet indices, MPV and PDW, in the diagnosis of immune thrombocytopenic purpura (ITP). Patients and methods The study population were divided into three groups: 15 patients with hyperdestructive thrombocytopenia and 15 with hypoproductive thrombocytopenia were compared with control group (15 healthy controls). The sensitivity and specificity of these platelet indices to diagnose immune thrombocytopenic purpura were also measured. Results The MPV showed a sensitivity of 93.3% and a specificity of 66.7% at a cutoff value of 7.7 fl, and the PDW showed a sensitivity of 86.7% and specificity of 73.3% at a cutoff value of 40.6%. Conclusion The study concluded that although MPV and PDW can be used as an initial hint for predicting the type of thrombocytopenia, they have limited sensitivity and specificity.

Use of the Platelet Indices for Differential Diagnosis of Pediatric Immune Thrombocytopenic Purpura ( ITP )

IntroductionThe prognosis of pediatric immune thrombocytopenic purpura (ITP) has a favorable prognosis, but it is difficult to predict the course of this disease at the time of diagnosis. Recent advances of automated blood cell analyzer enable to measure platelet indices such as mean platelet volume (MPV), platelet size deviation width (PDW) and platelet-large cell ratio (P-LCR). These have brought about some information for thrombocytopenia. We studied the significance of such platelet indices in the differential diagnosis of immune thrombocytopenic purpura (ITP) and their ability to discriminate the clinical courses of ITP.MethodsNinety-three patients were enrolled this study at our institution from 2004 to 2006. Their ages ranged from 1 to 17 years (media 4.3 years). Of 93, patients were divided into two goups for analysis, according to the diagnosis of ITP. 34 were diagnosed as ITP and 59 were diagnosed various blood diseases other than ITP. In these 59 non-ITP patients, five were with thrombocytopenia (platelet count < 100.0 x 109/L), the other without thrombocytopenia. Of 34 ITP patients, 29 were acute subtype and 5 were chronic. The Sysmex-XE2100 automated blood cell analyzer (Sysmex, Kobe, Japan) was used to measure the blood parameters, including the platelet indices.ResultsAccording to MPV, PDW and P-LCR, there were no significant differences between ITP patients and non-ITP. In children with ITP, there were significant inverse correlations between the platelet count and evaluated parameters, MPV (R2=0.376), PDW (R2=0.26) and P-LCR(R2=0.338). But no significant correlations were found between the platelet count and these evaluated platelet indices in non-ITP. Also, we have found all platelet indices were significantly higher in chronic ITP than in acute ITP. In particular, PDW (9.910 vs 13.080) and P-LCR (21.071 vs 33.220) showed marked differences between the two groups.ConclusionsITP is considered as a result of hyper-destruction of platelets. Increase of platelet count is regarded as decrease of destruction of platelets. Our data suggested that platelet indices, MPV, PDW and P-LCR showed the useful information for the degree of platelet destruction and the ability to predict the clinical courses of ITP. DisclosuresNo relevant conflicts of interest to declare.

Long-term results of laparoscopic splenectomy in pediatric chronic immune thrombocytopenic purpura.

PurposeLaparoscopic splenectomy (LS) for pediatric chronic immune thrombocytopenic purpura (ITP) patients has recently become widespread. However, its long-term result is rarely reported in children.MethodsWe retrospectively analyzed the patients who underwent LS for pediatric chronic ITP from June 1998 to April 2007.ResultsThere were 18 patients (14 male and 4 female) with mean age 9.5 ± 3.8 years. 14 complete response, 3 partial response, and 1 no response were occurred. During the 82-month median follow-up period, 9 patients maintained in a remission state without any additional treatment, and 9 patients relapsed. In a comparative analysis of the relapse group and no relapse group, hospital stays were longer in the relapse group and the preoperative platelet counts and platelet counts at 1 month post were lower in relapse group. A relapse-free survival among 17 patients who achieved partial or complete responses following LS showed 76.5%, 61.8%, and 33.0% at 1-, 5-, and 10-year following LS, respectively.ConclusionAlthough LS in pediatric chronic ITP patients had excellent results immediately after surgery, careful follow up is needed due to late relapse even when a complete response has been noted for several years.

Detection of expression of IL-18 and its binding protein in Egyptian pediatric immune thrombocytopenic purpura

Immune thrombocytopenic purpura (ITP) is an autoimmune disorder, characterized by dysfunctional cellular immunity including the presence of activated platelet specific autoreactive T cells that recognize and respond to autologous platelet antigens. Autoreactive T cells drive the generation of platelet reactive autoantibodies by B cells as well as T-cytotoxic cell-mediated lysis of platelets. Interleukin-18 (IL-18) is a mediator of T helper type 1 cell responses synergistically with IL-12 that initiate and promote host defense and inflammation. IL-18 has a specific binding protein (IL-18BP) which belongs to the immunoglobulin superfamily. In the present study, serum level and messenger RNA( mRNA) expression of IL-18 as well as IL-18BP mRNA expression were measured in peripheral blood mononuclear cells (PBMNCs) of 100 Egyptian pediatric patients with ITP (70 acute and 30 chronic). In addition to this, we recruited 80 healthy volunteers in order to investigate the possible association between the imbalance of IL-18 and IL-18 BP expressions and the pathogenesis of ITP. IL-18 serum level and mRNA expression were not elevated in cases more than in the control group, but IL-18 mRNA was higher in chronic cases when compared to the acute ones (p = 0.031) and there was a good negative correlation between the platelet count and serum IL-18. IL-18 BP m-RNA was slightly elevated in cases more than in the control group (95% Confidence interval = 1.15–2.01). Our results were not supportive for previous findings of elevated IL18/BP mRNA ratio in ITP patients. This could be referred to the fact that autoimmune diseases are complex genetic disorders, therefore further studies on polymorphisms affecting IL-18 gene expression as well as kinetics of IL-18 expression are required to evaluate the role of interleukin 18 and its binding protein in the pathogenesis of ITP.

DNMT3B promoter polymorphism and risk of immune thrombocytopenic purpura in pediatric Egyptians

Idiopathic (immune) thrombocytopenic purpura (ITP) is a heterogeneous clinical disorder characterized by immune-mediated platelet destruction. Epigenetic changes in gene expression, including DNA methylation and histone modifications, might contribute to autoimmunity. Polymorphisms of the DNA methyltransferase 3B (DNMT3B) gene may influence DNMT3B activity on DNA methylation and increase the susceptibility to several diseases. The current study investigated the association between a single nucleotide polymorphism (SNP) in the promoter of DNMT3B gene and the risk for ITP in pediatric Egyptians. DNMT3B SNP was genotyped by PCR-restriction fragment length polymorphism in 71 pediatric ITP patients and 82 healthy controls matched for age and sex. The C/C wild genotype was not detected in ITP patients or in the controls. The frequencies of the T/T and C/T genotypes were 93.9 and 6.1% in the controls and 91.5 and 6.1% in ITP patients, respectively. There was no significant difference in either genotypes or allelic distribution between ITP patients and the controls. In conclusion, this polymorphism was almost equally distributed between ITP patients and the controls. These results demonstrated that this SNP may not be used as a stratification marker to predict the susceptibility to childhood ITP in Egypt.

DNA methyltransferase 3B (DNMT3B − 579 G > T) promotor polymorphism and the susceptibility to pediatric immune thrombocytopenic purpura in Egypt

Idiopathic thrombocytopenic purpura (ITP) is an autoimmune disease characterized by increased platelet destruction. Although the etiology of ITP remains unclear, it is accepted that both environmental and genetic factors play an important role in the development of the disease. The present study aimed at exploring a novel molecular determinant that may influence the susceptibility and course of ITP in Egyptian children. To achieve our aim, genotyping of DNMT3B −579G>T promotor polymorphism by polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) assay. The current study was conducted on 140 ITP patients and 150 age and gender matched healthy controls. The results obtained revealed that DNMT3B −579 TT homotype was significantly higher in ITP patients and conferred almost three fold increased risk of ITP (OR=3.16, 95%CI=1.73–5.79). There was no statistically significant difference between ITP patients with wild or mutant genotypes as regards their clinical or laboratory data. Furthermore, there was no statistical difference in the distribution of DNMT3B −579G>T genotypes between acute and chronic ITP patients. In conclusion, DNMT3B −579G>T promotor polymorphism represents a novel genetic risk factor for ITP but not a predictor for tendency to chronicity in pediatric ITP in Egypt.

Comparison of anti-D immunoglobulin, methylprednisolone, or intravenous immunoglobulin therapy in newly diagnosed pediatric immune thrombocytopenic purpura

This study aimed to evaluate the efficacy, cost, and effects of anti-D immunoglobulin (anti-D Ig), methylprednisolone, or intravenous immunoglobulin (IVIG) therapy on the development of chronic disease in children who are Rh-positive with diagnosed immune thrombocytopenic purpura (ITP). Children with newly diagnosed ITP and platelet count <20,000/mm(3) were prospectively randomized to treatment with anti-D Ig (50 μg/kg), methylprednisolone (2 mg/kg/day), or IVIG (0.4 g/kg/day, 5 days). Sixty children with a mean age of 6.7 years were divided into three equal groups. No difference was observed between platelet counts before treatment and on day 3 of treatment. However, platelet counts at day 7 were lower in the methylprednisolone group than in the IVIG group (P = 0.03). In the anti-D Ig group, hemoglobin and hematocrit levels were significantly lower at the end of treatment (P < 0.05). Chronic ITP developed in 30% of the anti-D Ig group, 35% of the methylprednisolone group, and 25% of the IVIG group, but no significant difference was noted among the groups. The cost analysis revealed that the mean cost of IVIG was 7.4 times higher than anti-D Ig and 10.9 times higher than methylprednisolone. In the treatment of ITP in childhood, one 50 μg/kg dose of anti-D Ig has similar effects to IVIG and methylprednisolone. Among patients who were treated with anti-D Ig, serious anemia was not observed, and the cost of treatment was less than that of IVIG treatment.

FcγRIIa and FcγRIIIa genetic polymorphisms in a group of pediatric immune thrombocytopenic purpura in Egypt

Immune thrombocytopenic purpura (ITP) is an acquired autoimmune disorder caused by the production of antiplatelet antibodies. The current case-control study aimed at detecting the frequency of FcγRIIa-131H/R and FcγRIIIa-158F/V genes polymorphism in Egyptian children with ITP as genetic markers for ITP risk, and to clear out their possible role in choosing the treatment protocols of ITP. To achieve this aim, FcγRIIa genotyping was tested by PCR-restriction fragment length polymorphism (RFLP) technique, whereas FcγRIIIa genotyping was tested by nested PCR followed RFLP analysis. The current case-control study was conducted on 92 children with ITP; 12 acute and 80 chronic cases and 90 controls. The V allele and FcγRIIIa FV heterotype were significantly higher in ITP patients and conferred increased ITP risk [odds ratio (OR) = 1.96 and 2.55, respectively]. The frequency of FcγRIIa H allele was significantly higher among chronic ITP patients. In conclusion, FcγRIIIa gene polymorphism may contribute to susceptibility to ITP. Moreover, analysis of the FcγR polymorphisms in ITP patients could influence the effectiveness of medications and selection of the line of treatment.

Patterns of Inpatient Care for Acute Immune Thrombocytopenic Purpura in U.S. Children’s Hospitals, 2008–2010

Abstract 341 Background:A state of equipoise exists in the pediatric hematology community regarding the management of acute immune thrombocytopenic purpura (ITP). While studies have established that ITP treatment raises platelet counts, there is no evidence that treatment prevents serious hemorrhage. Recent guidelines from both an international expert panel and the American Society of Hematology recommend that children with no or mild bleeding be managed with observation alone, and hospitalization be reserved for those with clinically significant bleeding. There are no published data regarding current patterns of inpatient care for pediatric ITP, and the impact of guidelines on clinical practice cannot be determined unless a baseline is established. The objective of this study was to better understand current national practice patterns for acute ITP in United States children's hospitals and investigate regional differences in care. Methods:We examined data from the Pediatric Health Information System, a proprietary database containing clinical and financial data from 43 U.S. children’s hospital. Hospitals were divided into regions based on U.S. Census divisions. Data were extracted for all inpatients with ITP (ICD-9 code 287.31) aged 1–18 years discharged in 2008–2010. As our aim was to describe practice patterns for newly diagnosed acute ITP, patients were excluded if they had an ITP-related admission within six months prior to the study period. In patients with multiple ITP admissions during the study period, only the first admission was analyzed. To minimize the number of patients with thrombocytopenia due to other causes (ITP coding errors), we excluded those with other diagnoses associated with thrombocytopenia, such as cancer and lupus. We compared treatment strategies, length of stay, readmissions within 60 days, and total charges by region. Statistical analyses included χ2 tests for categorical outcomes and Kruskal-Wallis tests for ordinal outcomes. Results:Between 2008 and 2010, we identified 2,314 unique patients meeting the study diagnosis of acute ITP (Table). Only 13.1% of patients had an ICD-9 code suggestive of significant bleeding, with epistaxis the most commonly reported symptom. Even in our hospitalized population, <1% of patients had a diagnosis code of intracranial hemorrhage. We identified significant variation (p<0.05) by geographic region in all examined parameters (treatment strategies, length of stay, hospital charges, and likelihood of readmission). In all geographic regions, IVIG was the most utilized treatment strategy. The use of IVIG as a solitary therapy ranged from 66.2% of patients in Pacific states to 85.0% of patients in the West North Central region (MN, MO, KS). Mean length of stay ranged from 1.0–2.0 days among regions, with mean total charges per admission ranging from $12,460 in the New England/Mid-Atlantic region to $21,623 in the West South Central region (AR, LA, TX). Pharmacy costs accounted for 50% of charges. Rates of readmission within 60 days of initial ITP admission ranged from 5.5%-14.4% of patients. Conclusions:This analysis of the Pediatric Health Information System identified geographic variability in the use of ITP therapies and costs of care for children hospitalized with acute ITP in U.S. children's hospitals. While our data source did not allow us to determine platelet count or indication for hospitalization, our results suggest that a large number of children admitted with ITP in recent years did not have clinically significant bleeding, and potentially could have been managed with outpatient observation. Future studies will be able to identify if the number of ITP admissions, costs of care, and geographic variability in care decrease with the dissemination and implementation of recently published clinical guidelines.TableCharacteristics of 2314 pediatric inpatients with acute ITP, Pediatric Health Information System, 2008–2010(%)Males52.4Age1–3 years35.84–12 years42.113–18 years22.1ICD-9 bleeding codesEpistaxis7.9Menorrhagia2.3Gastrointestinal hemorrhage2.3Intracranial hemorrhage0.6Medication useIVIG72.2Corticosteroids alone7.8Anti-D4.8IVIG and Anti-D5.3No ITP treatment identified9.4Length of stay (days) − median, range2.0 days, 1–14Readmissions within 60 days10.1 Disclosures:No relevant conflicts of interest to declare.

Successful treatment of pediatric immune thrombocytopenic purpura associated with ulcerative colitis

Pediatrics InternationalVolume 53, Issue 5 p. 771-773 Successful treatment of pediatric immune thrombocytopenic purpura associated with ulcerative colitis Michinori Funato, Corresponding Author Michinori Funato Department of Pediatrics, Graduate School of Medicine, Gifu University, Gifu, JapanMichinori Funato, MD, PhD, Department of Pediatrics, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan. Email: [email protected]Search for more papers by this authorToshiyuki Fukao, Toshiyuki Fukao Department of Pediatrics, Graduate School of Medicine, Gifu University, Gifu, JapanSearch for more papers by this authorHideo Sasai, Hideo Sasai Department of Pediatrics, Graduate School of Medicine, Gifu University, Gifu, JapanSearch for more papers by this authorTomohiro Hori, Tomohiro Hori Department of Pediatrics, Graduate School of Medicine, Gifu University, Gifu, JapanSearch for more papers by this authorDaisuke Terazawa, Daisuke Terazawa Department of Pediatrics, Graduate School of Medicine, Gifu University, Gifu, JapanSearch for more papers by this authorKazuo Kubota, Kazuo Kubota Department of Pediatrics, Graduate School of Medicine, Gifu University, Gifu, JapanSearch for more papers by this authorMichio Ozeki, Michio Ozeki Department of Pediatrics, Graduate School of Medicine, Gifu University, Gifu, JapanSearch for more papers by this authorKenji Orii, Kenji Orii Department of Pediatrics, Graduate School of Medicine, Gifu University, Gifu, JapanSearch for more papers by this authorHideo Kaneko, Hideo Kaneko Department of Pediatrics, Graduate School of Medicine, Gifu University, Gifu, JapanSearch for more papers by this authorNaomi Kondo, Naomi Kondo Department of Pediatrics, Graduate School of Medicine, Gifu University, Gifu, JapanSearch for more papers by this author Michinori Funato, Corresponding Author Michinori Funato Department of Pediatrics, Graduate School of Medicine, Gifu University, Gifu, JapanMichinori Funato, MD, PhD, Department of Pediatrics, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan. Email: [email protected]Search for more papers by this authorToshiyuki Fukao, Toshiyuki Fukao Department of Pediatrics, Graduate School of Medicine, Gifu University, Gifu, JapanSearch for more papers by this authorHideo Sasai, Hideo Sasai Department of Pediatrics, Graduate School of Medicine, Gifu University, Gifu, JapanSearch for more papers by this authorTomohiro Hori, Tomohiro Hori Department of Pediatrics, Graduate School of Medicine, Gifu University, Gifu, JapanSearch for more papers by this authorDaisuke Terazawa, Daisuke Terazawa Department of Pediatrics, Graduate School of Medicine, Gifu University, Gifu, JapanSearch for more papers by this authorKazuo Kubota, Kazuo Kubota Department of Pediatrics, Graduate School of Medicine, Gifu University, Gifu, JapanSearch for more papers by this authorMichio Ozeki, Michio Ozeki Department of Pediatrics, Graduate School of Medicine, Gifu University, Gifu, JapanSearch for more papers by this authorKenji Orii, Kenji Orii Department of Pediatrics, Graduate School of Medicine, Gifu University, Gifu, JapanSearch for more papers by this authorHideo Kaneko, Hideo Kaneko Department of Pediatrics, Graduate School of Medicine, Gifu University, Gifu, JapanSearch for more papers by this authorNaomi Kondo, Naomi Kondo Department of Pediatrics, Graduate School of Medicine, Gifu University, Gifu, JapanSearch for more papers by this author First published: 28 September 2011 https://doi.org/10.1111/j.1442-200X.2010.03308.xCitations: 2Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Citing Literature Volume53, Issue5October 2011Pages 771-773 RelatedInformation

The Clinical Outcome of 260 Pediatric ITP Patients in One Center

In the current study, clinical and laboratory findings and treatment modalities of children with acute and chronic immune thrombocytopenic purpura (ITP) were evaluated retrospectively. Our purpose was to determine clinical outcome of children with ITP and their responses to different treatment regimes. Total of 260 children with ITP were enrolled in the study. The mean age of patients was 76.8 ± 48.1 months. The therapy responses of high-dose methylprednisolone (HDMP; n = 134), standard dose methylprednisolone (n = 32), and intravenous immunoglobulin (IVIG; n = 15) treatments were similar. Two (0.8%) of the 260 ITP patients had intracranial bleeding. None of the patients died due to hemorrhage. Of all the patients with ITP, 191 (73.5%) completely resolved within 6 months after initiation of the disease and therefore they were diagnosed as acute ITP; 69 patients (26.5%) had progressed into chronic ITP. The therapy responses of HDMP, standard dose methylprednisolone, and IVIG treatments are similar.

PLATELET MICROPARTICLES IN IMMUNE THROMBOCYTOPENIC PURPURA IN PEDIATRICS

Immune thrombocytopenic purpura (ITP) is one of the most common hemorrhagic disorders in childhood. Platelet microparticles (PMPs) arise with platelet activation with procoagulant activity. Elevated PMP levels in adult ITP were reported to be thrombogenic in certain settings. However, their clinical significance in pediatric ITP was not studied. The aims of this study were to assess PMP levels in ITP in children and adolescents, and its correlation with clinical status and bleeding score. The study included 40 ITP patients (20 acute aged 9 ± 2.19 years and 20 chronic aged 10.8 ± 4.7 years) randomly selected from the Hematology Clinic, Children's Hospital, Ain Shams University, Cairo, Egypt, and 30 sex- and age-matched healthy controls aged 9 ± 3.28 years. Patients were subjected to detailed history, assessment of bleeding score, complete hemogram, cytological bone marrow examination, and PMP quantification in peripheral blood by flow cytometry. Acute ITP patients had significant increase in PMPs, PMP/platelet count, and PMP percent compared to controls (P = .002, P < .0001, P < .0001, respectively) and compared to chronic ITP patients (P < .0001, P < .0001, P < .0001, respectively). PMPs were significantly decreased in chronic ITP patients compared to controls (P = .001), but PMP/platelet and PMP percent showed highly significant increase in chronic ITP (P < .0001). No correlation was evident between PMP levels and platelet count in either group (P > .05). Neither higher bleeding score nor thrombotic manifestations were observed in the studied ITP patients with high PMP levels. Elevated PMP levels may be protective against severe bleeding events in pediatric ITP. The role of PMP studies in deciding the management plan of childhood and adolescent ITP needs further evaluation.