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de Pablo JG, Zubicaray J, Iriondo J, Pérez Maroto F, Azorín D, de la Cruz Benito A, Sanz A, Madero L, González-Vicent M, Sevilla J, Sebastián E. Diagnostic yield of bone marrow aspiration in paediatric primary immune thrombocytopenia: impact of evolution and adherence to medical guidelines over the last 25 years. Eur J Pediatr 2024; 183:3445-3452. [PMID: 38771372 DOI: 10.1007/s00431-024-05583-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 04/03/2024] [Accepted: 04/21/2024] [Indexed: 05/22/2024]
Abstract
The aim of this study is to analyse the diagnostic value of bone marrow aspiration (BMA) in a retrospective cohort of patients with suspected immune thrombocytopaenia (ITP). We further measure changes in the percentage of patients who underwent this study and whether testing or not was in accordance with current guidelines at the time of diagnosis. We conducted a chart review of 243 patients with ITP who underwent follow-up in our institution between 1995 and 2022. The patients were divided into historical cohorts based on the practice guidelines of the Spanish Society of Pediatric Hematology and Oncology (SEHOP) and the American Society of Hematology (ASH) in place at the time of follow-up. For each case, time of disease presentation or initial diagnosis was defined as that which occurred in the first 72 h following disease onset. Based on data from the historical cohorts studied, we observed a lower total number of BMAs at diagnosis over time (p < 0.005). A gradual reduction was seen in the number of BMAs with the introduction of guidelines, including a progressively lower number of BMAs performed without indication (p < 0.05). Subsequent to the initial diagnosis, the procedure played a decisive role in only 2 patients (0.58%), allowing for a diagnosis of acquired aplastic anaemia in both cases. In both of them on diagnosis, BMA did not appear to be indicated, although subsequent analysis after 72 h raised suspicion of bone marrow failure. CONCLUSION BMA at presentation did not significantly alter the diagnosis in our cohort of patients with an initial suspicion of ITP, although the procedure was decisive in diagnosing 2 cases of acquired aplastic anaemia during the subsequent course of the disease. Regarding the number of aspirations performed, our findings show that increased physician compliance with current guidelines reduced the rate of unnecessary BMAs. WHAT IS KNOWN • BMA is a supplementary test for the diagnosis of ITP. • The usefulness of this invasive diagnostic procedure is not clearly stated in current guidelines. WHAT IS NEW • Adjustments to scientific guidelines have led to a reduction in the number of BMAs performed on our patients with suspected ITP in the last 27 years. • While the risks and benefits of BMA at the time of diagnosis are unclear in patients with suspected ITP, the procedure does not contribute significant information to support the diagnosis.
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Affiliation(s)
- Jesús González de Pablo
- Department of Haematology and Oncology, Niño Jesús University Children's Hospital. Av., Menéndez Pelayo 65, 28009, Madrid, Spain
- Foundation for Biomedical Research, Niño Jesús University Children's Hospital. Av., Menéndez Pelayo 65, 28009, Madrid, Spain
| | - Josune Zubicaray
- Department of Haematology and Oncology, Niño Jesús University Children's Hospital. Av., Menéndez Pelayo 65, 28009, Madrid, Spain
| | - June Iriondo
- Department of Haematology and Oncology, Niño Jesús University Children's Hospital. Av., Menéndez Pelayo 65, 28009, Madrid, Spain
- Foundation for Biomedical Research, Niño Jesús University Children's Hospital. Av., Menéndez Pelayo 65, 28009, Madrid, Spain
| | - Florencio Pérez Maroto
- Department of Haematology and Oncology, Niño Jesús University Children's Hospital. Av., Menéndez Pelayo 65, 28009, Madrid, Spain
| | - Daniel Azorín
- Servicio de Antomía Patológica, Niño Jesús University Children's Hospital. Av., Menéndez Pelayo 65, 28009, Madrid, Spain
| | - Ana de la Cruz Benito
- Department of Haematology and Oncology, Niño Jesús University Children's Hospital. Av., Menéndez Pelayo 65, 28009, Madrid, Spain
| | - Alejandro Sanz
- Department of Haematology and Oncology, Niño Jesús University Children's Hospital. Av., Menéndez Pelayo 65, 28009, Madrid, Spain
| | - Luis Madero
- Department of Haematology and Oncology, Niño Jesús University Children's Hospital. Av., Menéndez Pelayo 65, 28009, Madrid, Spain
| | - Marta González-Vicent
- Department of Haematology and Oncology, Niño Jesús University Children's Hospital. Av., Menéndez Pelayo 65, 28009, Madrid, Spain
| | - Julián Sevilla
- Department of Haematology and Oncology, Niño Jesús University Children's Hospital. Av., Menéndez Pelayo 65, 28009, Madrid, Spain.
| | - Elena Sebastián
- Department of Haematology and Oncology, Niño Jesús University Children's Hospital. Av., Menéndez Pelayo 65, 28009, Madrid, Spain
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González-López TJ, Alperovich G, Burillo E, Espejo-Saavedra Soler M, Rebollo-Gómez E, Hernández I, Justicia JL, Lozano ML. Epidemiology, Treatment Patterns, and Cost Analysis of Immune Thrombocytopenia in Spain between 2014 and 2020: A Population-based Study. TH OPEN 2024; 8:e252-e265. [PMID: 38983689 PMCID: PMC11230702 DOI: 10.1055/a-2336-1062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 05/06/2024] [Indexed: 07/11/2024] Open
Abstract
Background Immune thrombocytopenia (ITP) is characterised by low platelet counts and often leads to bleeding, fatigue, and reduced health-related quality of life. Methods This observational, retrospective, population-based study using BIG-PAC® database included Spanish paediatric and adult patients with primary ITP diagnosed in primary care and hospitals between 2014 and 2020 (median follow-up: 4 years). Epidemiology, baseline/clinical characteristics, treatment trends, healthcare resources and costs were analysed. Results The BIG-PAC® database contains records of 1,818,588 patients; 170 adults and 27 children with ITP were included in our analysis. ITP prevalence and annual incidence per 100,000 were estimated in 10.8 (2.8 in chronic ITP [cITP] patients) and 1.5 (0.3 in cITP patients), respectively. Epistaxis was the most common bleeding event, followed by genitourinary and gastrointestinal bleeding; >50%/> 75% of ITP/cITP patients reported fatigue. Chronic patients had lower platelet counts at baseline and required more transfusions. Corticosteroids, immunosuppressants, and thrombopoietin receptor agonists were the most used agents in first-, second- and third-line treatment, respectively. Thirty-five patients, all of them in chronic phase, underwent splenectomy. Patients had on average 13.9, 6.6, and 1.2 visits/year to primary care, haematology/internal medicine, and emergency departments, respectively. More than one-fourth of adult patients took on average 16.3 days of sick leave annually. Mean annual total health care costs were €10,741 (ITP patients) and €19,809 (cITP patients). Conclusion This is the first study to provide an overall perspective on the situation of the Spanish ITP population in terms of epidemiology, treatment trends, health care resources and costs, highlighting unmet patient needs, and direct and indirect costs/resource use between 2014 and 2020.
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Affiliation(s)
| | | | | | | | | | | | | | - María L Lozano
- Department of Haematology, Hospital General Universitario José María Morales Meseguer, Centro Regional de Hemodonación, Universidad de Murcia, IMIB-Pascual Parrilla, CIBERER-ISCIII, Murcia, Spain
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Gilanchi S, Faranoush M, Daskareh M, Sadjjadi FS, Zali H, Ghassempour A, Rezaei Tavirani M. Proteomic-Based Discovery of Predictive Biomarkers for Drug Therapy Response and Personalized Medicine in Chronic Immune Thrombocytopenia. BIOMED RESEARCH INTERNATIONAL 2023; 2023:9573863. [PMID: 37942029 PMCID: PMC10630023 DOI: 10.1155/2023/9573863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 09/17/2023] [Accepted: 09/30/2023] [Indexed: 11/10/2023]
Abstract
Purpose ITP is the most prevalent autoimmune blood disorder. The lack of predictive biomarkers for therapeutic response is a major challenge for physicians caring of chronic ITP patients. This study is aimed at identifying predictive biomarkers for drug therapy responses. Methods 2D gel electrophoresis (2-DE) was performed to find differentially expressed proteins. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometer (MALDI-TOF MS) analysis was performed to identify protein spots. The Cytoscape software was employed to visualize and analyze the protein-protein interaction (PPI) network. Then, enzyme-linked immunosorbent assays (ELISA) were used to confirm the results of the proteins detected in the blood. The DAVID online software was used to explore the Gene Ontology and pathways involved in the disease. Results Three proteins, including APOA1, GC, and TF, were identified as hub-bottlenecks and confirmed by ELISA. Enrichment analysis results showed the importance of several biological processes and pathway, such as the PPAR signaling pathway, complement and coagulation cascades, platelet activation, vitamin digestion and absorption, fat digestion and absorption, cell adhesion molecule binding, and receptor binding. Conclusion and Clinical Relevance. Our results indicate that plasma proteins (APOA1, GC, and TF) can be suitable biomarkers for the prognosis of the response to drug therapy in ITP patients.
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Affiliation(s)
- Samira Gilanchi
- Proteomics Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Faranoush
- Pediatric Growth and Development Research Center, Institute of Endocrinology, Iran University of Medical Sciences, Tehran, Iran
| | - Mahyar Daskareh
- Department of Radiology, Ziaeian Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Sadat Sadjjadi
- Proteomics Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hakimeh Zali
- Proteomics Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Ghassempour
- Medicinal Plants and Drugs Research Institute, Shahid Beheshti University, G.C., Evin, Tehran, Iran
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Berrueco R, González-Forster E, Deya-Martinez A, Solsona M, García-García A, Calzada-Hernández J, Yiyi L, Vlagea A, Ruiz-Llobet A, Alsina L. Mycophenolate mofetil for autoimmune cytopenias in children: high rates of response in inborn errors of immunity. Front Pediatr 2023; 11:1174671. [PMID: 37915985 PMCID: PMC10616248 DOI: 10.3389/fped.2023.1174671] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 09/25/2023] [Indexed: 11/03/2023] Open
Abstract
Second-line treatments of autoimmune cytopenias (AC) are not well-defined in children. Mycophenolate mofetil (MMF) is an immunosuppressant agent that has been demonstrated to be safe and effective in this setting. A retrospective observational study was conducted in 18 children with prolonged AC who received MMF, in order to describe clinical and biological markers of response. The overall response rate of MMF at 20-30 mg/kg per day was 73.3%. All patients with Evans syndrome (n = 9) achieved complete response. Among the patients with monolineage AC (n = 9), those with an underlying inborn errors of immunity (IEI), tended to respond better to MMF. No biological markers related to treatment response were found. Rather, lymphocyte subpopulations proved useful for patient selection as a marker suggestive of IEI along with immunoglobulin-level determination.
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Affiliation(s)
- Rubén Berrueco
- Pediatric Hematology Department, Hospital Sant Joan de Déu, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu de Barcelona (IRSJD), Barcelona, Spain
- Instituto Nacional de Investigación Biomédica en Enfermedades Raras (CIBER ER), Instituto de Salud Carlos III, Madrid, Spain
| | - Elisa González-Forster
- Pediatric Hematology Department, Hospital Sant Joan de Déu, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu de Barcelona (IRSJD), Barcelona, Spain
| | - Angela Deya-Martinez
- Institut de Recerca Sant Joan de Déu de Barcelona (IRSJD), Barcelona, Spain
- Clinical Immunology and Primary Immunodeficiencies Unit, Pediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain
- Clinical Immunology Unit, Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain
| | - María Solsona
- Pediatric Hematology Department, Hospital Sant Joan de Déu, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu de Barcelona (IRSJD), Barcelona, Spain
| | - Ana García-García
- Institut de Recerca Sant Joan de Déu de Barcelona (IRSJD), Barcelona, Spain
- Clinical Immunology and Primary Immunodeficiencies Unit, Pediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain
- Clinical Immunology Unit, Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain
| | - Joan Calzada-Hernández
- Pediatric Rheumatology Unit, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Luo Yiyi
- Clinical Immunology and Primary Immunodeficiencies Unit, Pediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain
- Clinical Immunology Unit, Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain
| | - Alexandru Vlagea
- Clinical Immunology Unit, Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain
- Immunology Department, Centre of Biomedical Diagnosis, Hospital Clínic, Barcelona, Spain
| | - Anna Ruiz-Llobet
- Pediatric Hematology Department, Hospital Sant Joan de Déu, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu de Barcelona (IRSJD), Barcelona, Spain
- Instituto Nacional de Investigación Biomédica en Enfermedades Raras (CIBER ER), Instituto de Salud Carlos III, Madrid, Spain
| | - Laia Alsina
- Institut de Recerca Sant Joan de Déu de Barcelona (IRSJD), Barcelona, Spain
- Clinical Immunology and Primary Immunodeficiencies Unit, Pediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain
- Clinical Immunology Unit, Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain
- Department of Surgery and Surgical Specializations, Facultat de Medicina I Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
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Cervantes-Pérez LA, Cervantes-Guevara G, Cervantes-Pérez E, Cervantes-Cardona GA, Nápoles-Echauri A, González-Ojeda A, Fuentes-Orozco C, Cervantes-Pérez G, Reyes-Torres CA, Hernández-Mora FJ, Ron-Magaña AL, Vázquez-Beltrán JC, Hernández-Rivas MI, Ramírez-Ochoa S. Evaluation of the Effects of Atorvastatin and N-Acetyl Cysteine on Platelet Counts in Patients with Primary Immune Thrombocytopenia: An Exploratory Clinical Trial. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1122. [PMID: 37374326 DOI: 10.3390/medicina59061122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023]
Abstract
Objective: We aimed to evaluate the efficacy of the combination of atorvastatin and N-acetyl cysteine in increasing platelet counts in patients with immune thrombocytopenia who were resistant to steroid therapy or had a relapse after treatment. Material and Methods: The patients included in this study received oral treatment of atorvastatin at a dose of 40 mg daily and N-acetyl cysteine at a dose of 400 mg every 8 h. The desired treatment duration was 12 months, but we included patients who completed at least 1 month of treatment in the analysis. The platelet counts were measured prior to the administration of the study treatment and in the first, third, sixth, and twelfth months of treatment (if available). A p value < 0.05 was considered statistically significant. Results: We included 15 patients who met our inclusion criteria. For the total treatment duration, the global response was 60% (nine patients); eight patients (53.3%) had a complete response and one patient (6.7%) had a partial response. Six patients (40%) were considered as having undergone treatment failure. Of the responder group, five patients maintained a complete response after treatment (55.5%), three patients maintained a partial response (33.3%), and one patient (11.1%) lost their response to the treatment. All of the patients in the responder group had significant increases in their platelet counts after treatment (p < 0.05). Conclusion: This study provides evidence of a possible treatment option for patients with primary immune thrombocytopenia. However, further studies are needed.
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Affiliation(s)
- Lorena A Cervantes-Pérez
- Department of Hematology, Hospital Civil de Guadalajaras "Fray Antonio Alcalde", Guadalajara 44280,, Mexico
| | - Gabino Cervantes-Guevara
- Department of Welfare and Sustainable Development, Centro Universitario del Norte, Universidad de Guadalajara, Colotlán 46200, Mexico
- Department of Gastroenterology, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara 44280, Mexico
| | - Enrique Cervantes-Pérez
- Department of Internal Medicine, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Health Sciences University Center, Universidad de Guadalajara, Guadalajara 44280, Mexico
- Centro Universitario de Tlajomulco, University of Guadalajara, Tlajomulco de Zúñiga 45641, Mexico
| | - Guillermo Alonso Cervantes-Cardona
- Department of Philosophical, Methodological and Instrumental Disciplines, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico
| | - Adriana Nápoles-Echauri
- Department of Philosophical, Methodological and Instrumental Disciplines, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico
| | - Alejandro González-Ojeda
- Biomedical Research Unit 02, Specialties Hospital of the Western National Medical Center, Mexican Institute of Social Security, Guadalajara 44329, Mexico
| | - Clotilde Fuentes-Orozco
- Biomedical Research Unit 02, Specialties Hospital of the Western National Medical Center, Mexican Institute of Social Security, Guadalajara 44329, Mexico
| | - Gabino Cervantes-Pérez
- Department of Internal Medicine, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Health Sciences University Center, Universidad de Guadalajara, Guadalajara 44280, Mexico
| | - Carlos A Reyes-Torres
- School of Health Sciences, Instituto Tecnológico y de Estudios Superiores de Monterrey, Mexico City 14380, Mexico
| | - Francisco Javier Hernández-Mora
- Human Reproduction, Growth and Child Development Clinic, Health Sciences University Center, Universidad de Guadalajara, Guadalajara 44340, Mexico
| | - Ana Lucia Ron-Magaña
- Department of Hematology, Hospital Civil de Guadalajaras "Fray Antonio Alcalde", Guadalajara 44280,, Mexico
| | | | - María Isabel Hernández-Rivas
- Departament of Odontology for the Preservation of Health, Health Sciences University Center, Universidad de Guadalajara, Guadalajara 44280, Mexico
| | - Sol Ramírez-Ochoa
- Department of Internal Medicine, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Health Sciences University Center, Universidad de Guadalajara, Guadalajara 44280, Mexico
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Tian H, Xu W, Wen L, Tang L, Zhang X, Song T, Yang C, Huang P. Association of PTPN22 SNP1858 (rs2476601) and Gene SNP1123 (rs2488457) Polymorphism With Primary Immune Thrombocytopenia Susceptibility: A Meta-Analysis of Case-Control Studies and Trial Sequential Analysis. Front Genet 2022; 13:893669. [PMID: 35692826 PMCID: PMC9174638 DOI: 10.3389/fgene.2022.893669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
Objective: Systematic review of the association of protein tyrosine phosphatase non-receptor type 22 (PTPN22) gene 1858 and 1123 sites single nucleotide polymorphism (SNP) with the susceptibility of primary immune thrombocytopenia (ITP). Method: Database searched includes PubMed, Embase, Web of Science, CNKI, CBM, VIP and WanFang Data. The retrieval period is from the establishment of the database to 30 June 2021. After screening articles according to inclusion and exclusion criteria, the data were extracted and methodological quality of the included studies was evaluated. Meta-analysis was performed using RevMan 5.4 and Stata 16.0 software. The combined OR value and its 95%CI were calculated. Sensitivity analysis and publication bias assessment were performed. Trial sequential analysis (TSA) was performed using TSA 0.9.5.10 Beta software. Results: A total of 10 studies with 10 articles were included, with a total of 932 cases and 2,112 controls. The results of meta-analysis showed that for SNP1858, the susceptibility of TT genotype to ITP was 5.01 times higher than CC genotype [95%CI (1.81, 13.86), p = 0.002]. For SNP1123, G allele carriers were more susceptible to ITP than C allele carriers [OR = 1.23, 95%CI (1.05, 1.45), p = 0.01], and GG genotype carriers were 1.51 times more susceptible to ITP than CC genotype carriers [95%CI (1.11, 2.06), p = 0.009]. Although the results are statistically significant, the results of sensitivity analysis showed certain limitations of stability, and the TSA analysis still indicated the possibility of false positive. No significant publication bias was observed. Conclusion: PTPN22 gene SNP1858 (rs2476601) and SNP1123 (rs2488457) polymorphisms are associated with susceptibility to primary immune thrombocytopenia. Due to the limitation of the number and quality of the included studies, the above conclusions need to be verified by more high-quality studies.
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Affiliation(s)
- Haokun Tian
- Joint Program of Nanchang University and Queen Mary University of London, Nanchang, China
| | - Weikai Xu
- Joint Program of Nanchang University and Queen Mary University of London, Nanchang, China
| | - Lequan Wen
- Joint Program of Nanchang University and Queen Mary University of London, Nanchang, China
- *Correspondence: Lequan Wen, ; Peng Huang,
| | - Lirui Tang
- Joint Program of Nanchang University and Queen Mary University of London, Nanchang, China
| | - Xinyuan Zhang
- Joint Program of Nanchang University and Queen Mary University of London, Nanchang, China
| | - Tiangang Song
- Joint Program of Nanchang University and Queen Mary University of London, Nanchang, China
| | - Changsen Yang
- Joint Program of Nanchang University and Queen Mary University of London, Nanchang, China
| | - Peng Huang
- Center for Evidence-based Medicine, School of Public Health, Nanchang University, Nanchang, China
- Jiangxi Province Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang, China
- *Correspondence: Lequan Wen, ; Peng Huang,
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Manejo de la trombocitopenia inmune primaria. Comparación de dos cohortes históricas. An Pediatr (Barc) 2021. [DOI: 10.1016/j.anpedi.2020.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Management of primary immune thrombocytopenia. A comparison between two historical cohorts. An Pediatr (Barc) 2021; 95:86-92. [PMID: 34246622 DOI: 10.1016/j.anpede.2020.09.007] [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: 06/09/2020] [Accepted: 09/07/2020] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION In recent years, there have been changes in the management of patients with primary immune thrombocytopenia. In this study, a review is presented of the characteristics and outcomes of children with primary immune thrombocytopenia in a children's hospital (Hospital Infantil Niño Jesús). Moreover, an analysis is made of the changes in the care of these patients diagnosed before and after 2011, when new guidelines were published by the Spanish Society of Paediatric Haematology Oncology (SEHOP). MATERIAL AND METHODS Data from a cohort of primary immune thrombocytopenia patients followed up in this hospital have been retrospectively reviewed. The statistical package used for the analysis was SPSS Statistics 22.0 (IBM Corp., Chicago, IL, USA). RESULTS A review is presented on the clinical data from 235 paediatric patients diagnosed with primary immune thrombocytopenia. It was observed that some features at diagnosis, such as age younger than five years and a previous history of infection, influenced the probability of cure. Regarding the changes in the management of patients since 2011, the steroid doses received during the first month and the first year, and the number of days corresponding to the patient's first admission have both significantly decreased. Splenectomies were also significantly reduced. CONCLUSIONS Since 2011, there have been changes in the medical care of our primary immune thrombocytopenia patients: they receive lower doses of steroids, they stay fewer days in the hospital, and the number of splenectomies has decreased without increasing bleeding or worsening the clinical evolution. Furthermore, it was observed that age younger than 5 years and a history of infection prior to diagnosis were related to higher chances of recovery.
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Berrueco R, Sebastián E, Solsona M, González de Pablo J, Ruiz‐Llobet A, Mesegué M, Gálvez E, Sevilla J. Secondary immune thrombocytopenia in children: Characteristics and outcome of a large cohort from two Spanish centres. Acta Paediatr 2021; 110:1952-1958. [PMID: 33460494 DOI: 10.1111/apa.15765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 12/23/2020] [Accepted: 01/15/2021] [Indexed: 11/27/2022]
Abstract
AIM To evaluate the incidence and outcome of secondary immune thrombocytopenia (ITP) in a large cohort of paediatric Spanish patients. METHODS A retrospective observational study was conducted in two paediatric University hospitals in Spain between 2009 and 2019, which included children from 4 months to 18 years old diagnosed with ITP. Data were recorded from clinical charts: gender, age at diagnosis, coexisting condition and associated characteristics, outcome and treatment. RESULTS Secondary ITP was diagnosed in 87 out of 442 patients (19.6%). Post-immunisation ITP was seen in younger children. The onset of secondary ITP to autoimmune diseases (AD) and immunodeficiencies (ID) was at an older age and had more tendency to be insidious, and platelet level was higher than primary ITP. Mean time from ITP onset to AD diseases or ID diagnosis was 1.2 and 2.6 years, respectively. Whereas the cumulative incidence of remission was significantly higher in post-immunisation and post-viral infection (compared with primary ITP patients), it was worse in AD and ID patients. CONCLUSIONS Identification of secondary ITP is important as it predicts outcome. Most of them are diagnosed at ITP onset, but AD diseases and ID should be ruled out periodically as they are usually identified later.
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Affiliation(s)
- Rubén Berrueco
- Pediatric Hematology Department Hospital Sant Joan de Déu Barcelona, Esplugues de Llobregat Barcelona Spain
- Institut de Recerca Pediàtrica Hospital Sant Joan de Déu de Barcelona (IRP‐HSJD0) Barcelona Spain
- Instituto Nacional de Investigación Biomédica en Enfermedades Raras (CIBER ER), Instituto de Salud Carlos III Madrid Spain
| | - Elena Sebastián
- Hematology Department Hospital Infantil Universitario Niño Jesús Madrid Spain
- Fundación Investigación Biomédica Hospital Infantil Niño Jesús (FIBHINJ) Madrid Spain
| | - María Solsona
- Pediatric Hematology Department Hospital Sant Joan de Déu Barcelona, Esplugues de Llobregat Barcelona Spain
- Institut de Recerca Pediàtrica Hospital Sant Joan de Déu de Barcelona (IRP‐HSJD0) Barcelona Spain
| | | | - Anna Ruiz‐Llobet
- Pediatric Hematology Department Hospital Sant Joan de Déu Barcelona, Esplugues de Llobregat Barcelona Spain
- Institut de Recerca Pediàtrica Hospital Sant Joan de Déu de Barcelona (IRP‐HSJD0) Barcelona Spain
| | - Montse Mesegué
- Pediatric Hematology Department Hospital Sant Joan de Déu Barcelona, Esplugues de Llobregat Barcelona Spain
- Institut de Recerca Pediàtrica Hospital Sant Joan de Déu de Barcelona (IRP‐HSJD0) Barcelona Spain
| | - Eva Gálvez
- Hematology Department Hospital Infantil Universitario Niño Jesús Madrid Spain
- Fundación Investigación Biomédica Hospital Infantil Niño Jesús (FIBHINJ) Madrid Spain
| | - Julián Sevilla
- Instituto Nacional de Investigación Biomédica en Enfermedades Raras (CIBER ER), Instituto de Salud Carlos III Madrid Spain
- Hematology Department Hospital Infantil Universitario Niño Jesús Madrid Spain
- Fundación Investigación Biomédica Hospital Infantil Niño Jesús (FIBHINJ) Madrid Spain
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Gil Piquer R, Calvo Rigual F. Primary immune thrombocytopenia: A review of cases in a district hospital. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.anpede.2019.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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11
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Gil Piquer R, Calvo Rigual F. Trombocitopenia inmune primaria: revisión de casuística en un hospital comarcal. An Pediatr (Barc) 2020; 93:335-337. [DOI: 10.1016/j.anpedi.2019.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/26/2019] [Accepted: 12/16/2019] [Indexed: 11/15/2022] Open
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