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Sirotich E, Nazaryan H, Chowdhury SR, Guyatt G, Agarwal A, Leong R, Wen A, Xu E, Liu B, Pallapothu S, Rathod P, Kwon HY, Dookie J, Shafiee A, Charness J, DiRaimo J, Paynter D, Pruitt B, Strachan G, Couban R, Ye Z, Arnold DM. Treatment of critical bleeding events in patients with immune thrombocytopenia: a protocol for a systematic review and meta-analysis. Syst Rev 2024; 13:21. [PMID: 38184622 PMCID: PMC10770981 DOI: 10.1186/s13643-023-02436-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 12/13/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND Critical bleeding events in adults and children with ITP are medical emergencies; however, evidence-based treatment protocols are lacking. Due to the severe thrombocytopenia, (typically platelet count less than 20 × 109/L), a critical bleed portends a high risk of death or disability. We plan to perform a systematic review and meta-analysis of treatments for critical bleeding in patients with ITP that will inform evidence-based recommendations. METHODS Literature searches will be conducted in four electronic databases: Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and PubMed. Eligible studies will be randomized controlled trials or observational studies that enrolled patients with ITP describing one or more interventions for the management of critical bleeding. Title and abstract screening, full-text screening, data extraction, and risk of bias evaluation will be conducted independently and in duplicate using Covidence and Excel. Outcomes will be pooled for meta-analysis where appropriate or summarized descriptively. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology will be used to evaluate the certainty of the evidence. Primary outcomes of interest will include frequency of critical bleeds, mortality and bleeding-related mortality, bleeding resolution, platelet count, and disability. DISCUSSION Evidence-based treatments for critical bleeding in patients with ITP are needed to improve patient outcomes and standardize care in the emergency setting. SYSTEMATIC REVIEW REGISTRATION CRD42020161206.
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Affiliation(s)
- Emily Sirotich
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Hasmik Nazaryan
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada
| | - Saifur Rahman Chowdhury
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Arnav Agarwal
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Russell Leong
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Aaron Wen
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada
| | - Emily Xu
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada
| | - Bonnie Liu
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada
| | - Sushmitha Pallapothu
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Preksha Rathod
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada
| | - Henry Y Kwon
- Department of Surgery, Henry Ford Health Systems, Detroit, MI, USA
| | - Jared Dookie
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada
| | - Amirmohammad Shafiee
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada
| | - Jay Charness
- Platelet Disorder Support Association (PDSA), Cleveland, OH, USA
| | - Jennifer DiRaimo
- Platelet Disorder Support Association (PDSA), Cleveland, OH, USA
| | - Dale Paynter
- Platelet Disorder Support Association (PDSA), Cleveland, OH, USA
| | - Barbara Pruitt
- Platelet Disorder Support Association (PDSA), Cleveland, OH, USA
| | - Gail Strachan
- Platelet Disorder Support Association (PDSA), Cleveland, OH, USA
| | - Rachel Couban
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Zhikang Ye
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Donald M Arnold
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada.
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CT-001 is a rapid clearing factor VIIa with enhanced clearance and hemostatic activity for the treatment of acute bleeding in non-hemophilia settings. Thromb Res 2022; 215:58-66. [DOI: 10.1016/j.thromres.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/16/2022] [Indexed: 11/21/2022]
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3
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Sim DS, Mallari CR, Teare JM, Feldman RI, Bauzon M, Hermiston TW. In vitro characterization of CT-001-a short-acting factor VIIa with enhanced prohemostatic activity. Res Pract Thromb Haemost 2021; 5:e12530. [PMID: 34263099 PMCID: PMC8265787 DOI: 10.1002/rth2.12530] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 04/12/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Traumatic injury and the associated acute bleeding are leading causes of death in people aged 1 to 44 years. Acute bleeding in pathological and surgical settings also represents a significant burden to the society. Yet there are no approved hemostatic drugs currently available. While clinically proven as an effective pro-coagulant, activated factor VII (FVIIa) use in acute bleeding has been hampered by unwanted thromboembolic events. Enhancing the ability of FVIIa to quickly stop a bleed and clear rapidly from circulation may yield an ideal molecule suitable for use in patients with acute bleeding. OBJECTIVES To address this need and the current liability of FVIIa, we produced a novel FVIIa molecule (CT-001) with enhanced potency and shortened plasma residence time by cell line engineering and FVIIa protein engineering for superior efficacy for acute bleeding and safety. METHODS To address safety, CT-001, a FVIIa protein with 4 desialylated N-glycans was generated to promote active recognition and clearance via the asialoglycoprotein receptor. To enhance potency, the gamma-carboxylated domain was modified with P10Q and K32E, which enhanced membrane binding. RESULTS Together, these changes significantly enhanced potency and clearance while retaining the ability to interact with the key hemostatic checkpoint proteins antithrombin and tissue factor pathway inhibitor. CONCLUSIONS These results demonstrate that a FVIIa molecule engineered to combine supra-physiological activity and shorter duration of action has the potential to overcome the current limitations of recombinant FVIIa to be a safe and effective approach to the treatment of acute bleeding.
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Affiliation(s)
| | | | | | | | - Maxine Bauzon
- Were employed at Bayer HealthCare when part of this study was performed
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4
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[Emergency treatment of severe bleeding in immune thrombocytopenia]. Anaesthesist 2021; 70:598-602. [PMID: 33728478 DOI: 10.1007/s00101-021-00939-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 12/23/2020] [Accepted: 01/20/2021] [Indexed: 11/26/2022]
Abstract
Immune thrombozytopenia (ITP) is a rare acquired thrombocytopenia occurring in 2 to 4 persons per 100,000 per year. ITP is defined as a platelet count less than 100 G/l in patients in whom other causes of thrombocytopenia have been ruled out. Severe bleeding is rare but may constitute a life-threatening condition. Therapeutic options include platelet transfusions, glucocorticoids and intravenous immune globuline (IVIG). Emergency splenectomy has to be considered in otherwise untreatable bleeding. We present the case of a 65-year-old patient with chronic refractory ITP and finally fatal bleeding.
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5
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Factor VIIa. Platelets 2019. [DOI: 10.1016/b978-0-12-813456-6.00063-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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6
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Liu XG, Bai XC, Chen FP, Cheng YF, Dai KS, Fang MY, Feng JM, Gong YP, Guo T, Guo XH, Han Y, Hong LJ, Hu Y, Hua BL, Huang RB, Li Y, Peng J, Shu MM, Sun J, Sun PY, Sun YQ, Wang CS, Wang SJ, Wang XM, Wu CM, Wu WM, Yan ZY, Yang FE, Yang LH, Yang RC, Yang TH, Ye X, Zhang GS, Zhang L, Zheng CC, Zhou H, Zhou M, Zhou RF, Zhou ZP, Zhu HL, Zhu TN, Hou M. Chinese guidelines for treatment of adult primary immune thrombocytopenia. Int J Hematol 2018; 107:615-623. [PMID: 29619624 DOI: 10.1007/s12185-018-2445-z] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 03/22/2018] [Accepted: 03/22/2018] [Indexed: 02/05/2023]
Abstract
Primary immune thrombocytopenia (ITP) is a bleeding disorder commonly encountered in clinical practice. The International Working Group (IWG) on ITP has published several landmark papers on terminology, definitions, outcome criteria, bleeding assessment, diagnosis, and management of ITP. The Chinese consensus reports for diagnosis and management of adult ITP have been updated to the 4th edition. Based on current consensus positions and new emerging clinical evidence, the thrombosis and hemostasis group of the Chinese Society of Hematology issued Chinese guidelines for management of adult ITP, which aim to provide evidence-based recommendations for clinical decision making.
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Affiliation(s)
- Xin-Guang Liu
- Department of Hematology, Qilu Hospital, Shandong University, Jinan, 250012, China
| | - Xiao-Chuan Bai
- General Hospital of Ningxia Medical University, Yinchuan, China
| | - Fang-Ping Chen
- Xiangya Hospital, Centre South University, Changsha, China
| | | | - Ke-Sheng Dai
- The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Mei-Yun Fang
- The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | | | - Yu-Ping Gong
- West China Hospital, Sichuan University, Chengdu, China
| | - Tao Guo
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xin-Hong Guo
- The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, China
| | - Yue Han
- The First Affiliated Hospital of Soochow University, Suzhou, China
| | | | - Yu Hu
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bao-Lai Hua
- Northern Jiangsu People's Hospital, Yangzhou, China
| | - Rui-Bing Huang
- The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yan Li
- The First Hospital of Chinese Medical University, Shenyang, China
| | - Jun Peng
- Department of Hematology, Qilu Hospital, Shandong University, Jinan, 250012, China
| | - Mi-Mi Shu
- Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Jing Sun
- Nanfang Hospital, Nanfang Medical University, Guangzhou, China
| | - Pei-Yan Sun
- Xinqiao Hospital, The Third Military Medical University, Chongqing, China
| | - Yu-Qian Sun
- Peking University People's Hospital, Beijing, China
| | - Chun-Sen Wang
- Sichuan Provincial People's Hospital, Chengdu, China
| | - Shu-Jie Wang
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiao-Min Wang
- People's Hospital of Xinjiang Uygur Autonomous Region, Ürümqi, China
| | - Cong-Ming Wu
- Hainan Provincial People's Hospital, Haikou, China
| | - Wen-Man Wu
- Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Zhen-Yu Yan
- Affiliated Hospital of North China University of Science and Technology, Tangshan, China
| | - Feng-E Yang
- Union Hospital of Fujian Medical University, Fuzhou, China
| | - Lin-Hua Yang
- The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Ren-Chi Yang
- Institute of Haematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences, Tianjin, China
| | - Tong-Hua Yang
- The First People's Hospital of Yunnan Province, Kunming, China
| | - Xu Ye
- The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Guang-Sen Zhang
- The Second Xiangya Hospital, Central South University, Changsha, China
| | - Lei Zhang
- Institute of Haematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences, Tianjin, China
| | | | - Hu Zhou
- Henan Cancer Hospital, Zhengzhou, China
| | - Min Zhou
- Chengdu Women and Children's Hospital, Chengdu, China
| | | | - Ze-Ping Zhou
- The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Hong-Li Zhu
- Chinese PLA General Hospital, Beijing, China
| | - Tie-Nan Zhu
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ming Hou
- Department of Hematology, Qilu Hospital, Shandong University, Jinan, 250012, China.
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7
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Kühne T. Diagnosis and management of immune thrombocytopenia in childhood. Hamostaseologie 2016; 37:36-44. [PMID: 27699328 DOI: 10.5482/hamo-16-06-0017] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 09/20/2016] [Indexed: 01/19/2023] Open
Abstract
Evidence-based medicine is growing in immune thrombocytopenia (ITP), but solid clinical data are still lacking in many areas. A majority of children has self-limited ITP, but chronic symptomatic ITP exists also in pediatrics. Management includes a watch-and-wait strategy for children with newly diagnosed ITP and no or mild bleeding, and immunoglobulins and corticosteroids, if more bleeding and mucous membrane involvement is present. Treatment endpoints differ in clinical research and in clinical practice. The requirement of platelet enhancing drugs needs to be better defined in guidelines. Second-line therapies for children are rarely required and include thrombopoietin-receptor agonists, rituximab, dexamethasone and immunosuppressants. Thrombopoietin-receptor agonists are successful in adult but also in pediatric ITP. The strategical position of splenectomy differs from that in adults. Although effective in children it is less frequently used because of its life-long cumulative risk of infectious diseases and a higher potential of spontaneous remission in ITP, providing a strong argument to defer splenectomy. The rarity of ITP makes clinical research expensive.
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Affiliation(s)
- Thomas Kühne
- Thomas Kühne, MD, Division of Oncology / Hematology, University Children's Hospital, Spitalstrasse 33, 4031 Basel, Switzerland, Phone: +41-61-704-1212, Fax: +41-61-704-1213, E-Mail:
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8
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Pagovich OE, Lebastchi AH, Romberg N. Peri-operative considerations in the patient with primary immune deficiency: a review. Surg Infect (Larchmt) 2015; 15:672-8. [PMID: 25317569 DOI: 10.1089/sur.2013.196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Patients with inherited immune deficiency diseases often require surgical procedures, and their immune defects may predispose them to surgical complications. METHODS A thorough review of pertinent literature and current practice guidelines on surgery in patients with immune deficiency. RESULTS Peri-operative infections are a key, but not a singular, consideration in managing patients with a primary immune deficiency. Bleeding diathesis, gastrointestinal complications, pulmonary complications, and poor incision healing may also be idiosyncratic features unique to particular immune deficiency diseases. Patients with complex genetic syndromes that include immune deficiency also may display non-immunologic abnormalities that are equally important to surgical care. CONCLUSION Greater awareness of primary immune deficiencies and a comprehensive evaluation of such patients in close consultation with an immunologist can minimize surgical complications and optimize patient outcomes.
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Affiliation(s)
- Odelya E Pagovich
- 1 Section of Allergy and Clinical Immunology, Department of Internal Medicine and Pediatrics, Yale University School of Medicine , New Haven, Connecticut
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9
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Successful management of refractory immune thrombocytopenia associated with massive alveolar hemorrhage. Transfus Apher Sci 2015; 52:214-6. [PMID: 25634787 DOI: 10.1016/j.transci.2015.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 01/05/2015] [Indexed: 11/23/2022]
Abstract
Immune thrombocytopenia (ITP) is an acquired immune-mediated disease characterized by persistant thrombocytopenia. Onset of the disease and the clinical course is highly variable, but the disease typically has a benign course. Patients rarely develop serious life-threatening bleeding. Herein, a case with refractory ITP and massive alveolar hemorrhage who was successfully treated with a fast and sequential approach is presented for the first time.
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10
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Cooper N. A review of the management of childhood immune thrombocytopenia: how can we provide an evidence-based approach? Br J Haematol 2014; 165:756-67. [DOI: 10.1111/bjh.12889] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 03/12/2014] [Indexed: 01/19/2023]
Affiliation(s)
- Nichola Cooper
- Department of Haematology; Hammersmith Hospital; Imperial College; London UK
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11
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In vitro evaluation of clot quality and stability in a model of severe thrombocytopenia: effect of fibrinogen, factor XIII and thrombin-activatable fibrinolysis inhibitor. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2013; 12:78-84. [PMID: 24333083 DOI: 10.2450/2013.0068-13] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 09/04/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND The treatment options in severe thrombocytopenia (platelet count ≤20×10(9)/L) are limited. The aim of this study was to investigate ways of improving blood clotting and stability in reconstituted thrombocytopenia. MATERIALS AND METHODS Thrombocytopenia (platelets [16±4]×10(9)/L) was created by differential centrifugation of normal blood followed by reconstitution of whole blood which was subjected to clotting in a rotation thromboelastometer by CaCl2 and tissue factor, and to fibrinolysis by tissue plasminogen activator (tPA). In separate experiments, blood was diluted by 40% with TRIS/saline solution. Blood was treated with fibrinogen (fib), factor XIII (FXIII), and thrombin-activatable fibrinolysis inhibitor (TAFI). RESULTS The maximum clot firmness of thrombocytopenic blood was approximately 2-fold less than that of intact blood. Supplementation of blood with fib and FXIII improved clot formation. In the presence of tPA, among fib, FXIII and TAFI, only fib stimulated clot propagation whereas each of these agents increased clot strength. There was a synergistic effect when fib was added together with FXIII or TAFI. Fibrinolysis was inhibited by TAFI and to a greater extent by TAFI + FXIII. Fourty percent dilution of blood reduced clot strength and increased susceptibility to tPA. Clot strength was increased by the treatments in the following order: fib/FXIII/TAFI > fib/TAFI > fib > TAFI > FXIII. In the presence of tPA, TAFI and FXIII lysed the clots significantly more slowly. This effect was stronger when blood was treated with the combination of fib/FXIII/TAFI. Doubling the fib concentration, alone or together with other agents, did not improve clot strength or stability. DISCUSSION Augmentation of clot formation and anti-fibrinolysis by combining fib, FXIII and TAFI may be beneficial for the treatment of patients with severe thrombocytopenia especially when complicated by haemodilution following introduction of fluids to compensate for massive blood loss.
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12
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Haffner E, Pietsch U, Fösel T, Lindemann W. [Treatment of a pregnant patient after multiple trauma: rare combination with thrombotic thrombocytopenic purpura]. Anaesthesist 2013; 62:125-9. [PMID: 23400712 DOI: 10.1007/s00101-012-2130-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 12/13/2012] [Accepted: 12/14/2012] [Indexed: 10/27/2022]
Abstract
Multiple trauma during pregnancy is a relatively rare situation which poses a great challenge for the team in charge of treatment. A concomitant disease, such as thrombotic thrombocytopenic purpura (TTP) with thrombocytic coagulopathy increases the complexity of the treatment problems. This article describes the case of a 36-year-old pregnant woman referred to this hospital suffering from multiple trauma with severe liver rupture. Stabilization was achieved after an emergency Caesarean section and packing of the liver. Recurrent massive bleeding from the liver occurred after depacking and was treated successfully with recombinant factor VIIa. The concomitant TTP was treated by transfusion of fresh frozen plasma and corticosteroids. Rapid initiation of therapy was the goal to achieve hemostasis and prevent aggravation of the coagulation disorder and an unfavourable outcome despite severe thrombocytopenia.
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Affiliation(s)
- E Haffner
- Klinik für Anästhesiologie und Operative Intensivmedizin, Ortenauklinikum Lahr-Ettenheim, Klostenstr. 19, 77933 Lahr, Deutschland.
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13
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Factor VIIa. Platelets 2013. [DOI: 10.1016/b978-0-12-387837-3.00061-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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14
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Gurion R, Siu A, Weiss AR, Masterson M. Use of Recombinant Factor VIIa in a Pediatric Patient With Initial Presentation of Refractory Acute Immune Thrombocytopenic Purpura and Severe Bleeding. J Pediatr Pharmacol Ther 2012; 17:274-80. [PMID: 23258971 DOI: 10.5863/1551-6776-17.3.274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Severe bleeding in acute immune thrombocytopenic purpura (ITP) is rare but can cause significant complications to the patient. Here we report the case of a pediatric patient with acute ITP and hematuria refractory to anti-D immune globulin, high dose intravenous immunoglobulin G, and high dose steroids. Her hematuria was successfully treated with recombinant factor VIIa (rFVIIa). While further investigation on the use of rFVIIa in ITP is warranted, this case report contributes to the pediatric literature for its use during the course of an initial presentation of ITP with hemorrhagic complications.
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Affiliation(s)
- Reut Gurion
- Division of Pediatric Rheumatology, University Hospitals Case Medical Center, Rainbow Babies & Children's Hospital, Cleveland, Ohio
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Larsen OH, Stentoft J, Radia D, Ingerslev J, Sørensen B. Combination of recombinant factor VIIa and fibrinogen corrects clot formation in primary immune thrombocytopenia at very low platelet counts. Br J Haematol 2012; 160:228-36. [DOI: 10.1111/bjh.12118] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Accepted: 09/12/2012] [Indexed: 11/26/2022]
Affiliation(s)
| | - Jesper Stentoft
- Department of Haematology; Aarhus University Hospital; Aarhus; Denmark
| | - Deepti Radia
- Department of Haematology; Guy's and St Thomas' NHS Foundation Trust; London; UK
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Anoop P. Immune thrombocytopenic purpura: historical perspective, current status, recent advances and future directions. Indian Pediatr 2012; 49:811-8. [PMID: 23144100 DOI: 10.1007/s13312-012-0195-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Immune thrombocytopenic purpura (ITP) has witnessed many changes and updates over the past decade. The definitions of disease subtypes, course and response to treatment have all been standardized recently. Consequent to the lack of an international consensus management guideline, wide variations exist in treatment practice. This is now being addressed to an extent by the much awaited ITP International Working Group 2010 recommendations. The pathophysiologic mechanisms have been unfolded at cellular, molecular and humoral levels. As a result, many recent advances have taken place in the management of this disorder. This review revisits the history of evolution of ITP, summarizes the current recommendations for management and lists the recent advances and future prospects in this field.
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Affiliation(s)
- P Anoop
- Department of Pediatric Hemato-Oncology, Great Ormond Street Hospital for Children, London, United Kingdom.
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17
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Stasi R. Pathophysiology and therapeutic options in primary immune thrombocytopenia. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2011; 9:262-73. [PMID: 21251458 PMCID: PMC3136592 DOI: 10.2450/2010.0080-10] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/12/2010] [Accepted: 10/11/2010] [Indexed: 01/11/2023]
Affiliation(s)
- Roberto Stasi
- Department of Haematology, St George's Hospital, Blackshaw Road, London, United Kingdom.
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18
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The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia. Blood 2011; 117:4190-207. [PMID: 21325604 DOI: 10.1182/blood-2010-08-302984] [Citation(s) in RCA: 1257] [Impact Index Per Article: 96.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Immune thrombocytopenia (ITP) is commonly encountered in clinical practice. In 1996 the American Society of Hematology published a landmark guidance paper designed to assist clinicians in the management of this disorder. Since 1996 there have been numerous advances in the management of both adult and pediatric ITP. These changes mandated an update in the guidelines. This guideline uses a rigorous, evidence-based approach to the location, interpretation, and presentation of the available evidence. We have endeavored to identify, abstract, and present all available methodologically rigorous data informing the treatment of ITP. We provide evidence-based treatment recommendations using the GRADE system in those areas in which such evidence exists. We do not provide evidence in those areas in which evidence is lacking, or is of lower quality--interested readers are referred to a number of recent, consensus-based recommendations for expert opinion in these clinical areas. Our review identified the need for additional studies in many key areas of the therapy of ITP such as comparative studies of "front-line" therapy for ITP, the management of serious bleeding in patients with ITP, and studies that will provide guidance about which therapy should be used as salvage therapy for patients after failure of a first-line intervention.
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19
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[Efficacy of recombinant activated factor VII in diffuse alveolar haemorrhage]. Rev Mal Respir 2011; 28:106-11. [PMID: 21277485 DOI: 10.1016/j.rmr.2010.07.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2009] [Accepted: 07/04/2010] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Alveolar haemorrhage is a serious complication of a range of different pathologies. Published recent literature has reported only cases unresponsive to the usual treatment (steroids, transfusions, immunosuppressors and mechanical ventilation) as well as multiple secondary complications of these kinds of therapies. Recombinant activated factor VII (rF VIIa) is a new class of agent, which appears to be a successful adjunct therapy in the case of failure of conventional treatments. OBSERVATIONS We describe two cases of alveolar haemorrhage treated with rF VIIa. The first patient had leukaemia and the second had ANCA-associated granulomatous vasculitis. Both were admitted to the intensive care unit for mechanical ventilation with persistent diffuse alveolar haemorrhage that responded only to a single dose of rF VIIa (90 μg/kg). DISCUSSION AND CONCLUSION rF VIIa is a promising treatment for diffuse, persistent alveolar haemorrhage, with only a small dose required to be effective. Future studies are needed in order to establish a clear protocol for the administration of this novel agent.
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Khellaf M. Prise en charge du purpura thrombopénique immunologique de l’adulte. Rev Med Interne 2010; 31 Suppl 3:S329-32. [DOI: 10.1016/j.revmed.2010.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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