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Medovic RH, Srejovic IM, Medovic MV, Milosavljevic IM, Nikolic MR, Stojanovic AZ, Kuzmanovic MB, Djurdjevic PM, Bolevich SB, Fisenko VP, Jakovljevic VL, Igrutinovic ZR. Variations of Redox Balance in Different Stages of Childhood Immune Thrombocytopenic Purpura. Thromb Haemost 2023; 123:1129-1139. [PMID: 37604187 DOI: 10.1055/s-0043-1772683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
BACKGROUND Few previous studies indicated the role of oxidative stress in the pathogenesis of childhood idiopathic thrombocytopenic purpura (ITP), but there are little data regarding changes in redox balance in different forms of the disease, and changes after therapeutic procedures. We aimed to investigate the values of pro-oxidants and antioxidative capacity in various forms of ITP before and after the applying therapy. MATERIALS AND METHODS The research included 102 children, classified into the following groups: (1) newly diagnosed ITP (ndITP), (2) persistent ITP, (3) chronic ITP (chITP), and (4) control groups: (A) healthy control and (B) previously experienced ITP-healthy children who had been suffering from ITP earlier. During the clinical assessment, a blood sample was taken from the patients, from which the value of pro-oxidants (index of lipid peroxidation measured as TBARS, nitrites [NO2 -], as measurement of nitric oxide [NO] production, superoxide anion radical [O2 -], and hydrogen peroxide [H2O2]) and the capacity of antioxidant protection (activity of superoxide dismutase and catalase, and quantity of reduced glutathione) were determined spectrophotometrically. RESULTS Our results demonstrated that values of pro-oxidants, especially reflected through the TBARS and O2 -, were the highest in the ndITP and exacerbated chITP groups. Also, the activity of the endogenous antioxidative defense system was the lowest in these groups. Intravenous immunoglobulin therapy in the ndITP group exerted the most prominent effect on the redox balance. CONCLUSION It can be concluded that severity and exacerbation of the ITP are closely related to the redox status.
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Affiliation(s)
- Rasa H Medovic
- Department of Pediatrics, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- University Clinical Center Kragujevac, Kragujevac, Serbia
| | - Ivan M Srejovic
- Department of Physiology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Center of Excellence for the Study of Redox Balance in Cardiovascular and Metabolic Disorders, University of Kragujevac, Kragujevac, Serbia
- Department of Pharmacology, First Moscow State Medical University I.M. Sechenov, Moscow, Russian Federation
| | - Marija V Medovic
- University Clinical Center Kragujevac, Kragujevac, Serbia
- Department of Dermatovenerology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Isidora M Milosavljevic
- Center of Excellence for the Study of Redox Balance in Cardiovascular and Metabolic Disorders, University of Kragujevac, Kragujevac, Serbia
- Department of Pharmacy, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Marina R Nikolic
- Department of Physiology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Center of Excellence for the Study of Redox Balance in Cardiovascular and Metabolic Disorders, University of Kragujevac, Kragujevac, Serbia
| | - Aleksandra Z Stojanovic
- Center of Excellence for the Study of Redox Balance in Cardiovascular and Metabolic Disorders, University of Kragujevac, Kragujevac, Serbia
- Department of Pharmacy, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Milos B Kuzmanovic
- Mother and Child Health Institute of Serbia "Dr Vukan Cupic", Belgrade, Serbia
- Department of Pediatrics, Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Predrag M Djurdjevic
- University Clinical Center Kragujevac, Kragujevac, Serbia
- Department of Internal medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Sergey B Bolevich
- Department of Human Pathology, First Moscow State Medical University I.M. Sechenov, Moscow, Russia Federation
| | - Vladimir P Fisenko
- Department of Pharmacology, First Moscow State Medical University I.M. Sechenov, Moscow, Russian Federation
| | - Vladimir Lj Jakovljevic
- Department of Physiology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Center of Excellence for the Study of Redox Balance in Cardiovascular and Metabolic Disorders, University of Kragujevac, Kragujevac, Serbia
- Department of Human Pathology, First Moscow State Medical University I.M. Sechenov, Moscow, Russia Federation
| | - Zoran R Igrutinovic
- Department of Pediatrics, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- University Clinical Center Kragujevac, Kragujevac, Serbia
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Rosu VE, Roșu ST, Ivanov AV, Starcea IM, Streanga V, Miron IC, Mocanu A, Lupu A, Lupu VV, Gavrilovici C. Predictor Factors for Chronicity in Immune Thrombocytopenic Purpura in Children. CHILDREN (BASEL, SWITZERLAND) 2023; 10:911. [PMID: 37371143 DOI: 10.3390/children10060911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 05/11/2023] [Accepted: 05/18/2023] [Indexed: 06/29/2023]
Abstract
(1) Background: Immune thrombocytopenia (ITP) is an acute autoimmune blood disorder that is the main cause of thrombocytopenia in children. It is characterized by a decrease in platelets below 100 × 109/L, and limited evolution with severe complications such as intracranial hemorrhage. The chronic form is defined by the persistence of thrombocytopenia more than 12 months after diagnosis. (2) Methods: We performed a retrospective study over a period of 10 years (1 January 2011-31 December 2020) at the Emergency Clinical Hospital for Children "Sf. Maria", Iasi. The aim of the study was to describe the clinical characteristics and to determine the prognostic factors in immune thrombocytopenia in children. (3) Results: In this study we included 271 children with ITP, comprising 123 females (45.4%) and 148 males (54.6%). The remission rate was higher in males, being 68.9% compared to 56.1% in females. Children with ITP under 9 years of age had a higher remission rate. Children with a platelet count > 10 × 109/L at diagnosis had a higher likelihood-of-remission rate compared to patients who presented initial platelet count below this value. (4) Conclusions: The risk factors highly suggestive for chronicity are: age at diagnosis, female sex, and the number of platelets at the onset of the disease.
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Affiliation(s)
- Vasile Eduard Rosu
- Pediatrics, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Solange Tamara Roșu
- Nursing, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Anca Viorica Ivanov
- Pediatrics, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | | | - Violeta Streanga
- Pediatrics, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | | | - Adriana Mocanu
- Pediatrics, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Ancuta Lupu
- Pediatrics, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Vasile Valeriu Lupu
- Pediatrics, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Cristina Gavrilovici
- Pediatrics, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
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3
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Long-term efficacy and safety profile of splenectomy for pediatric chronic immune thrombocytopenia. Int J Hematol 2023; 117:774-780. [PMID: 36622550 DOI: 10.1007/s12185-022-03529-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 12/27/2022] [Accepted: 12/27/2022] [Indexed: 01/10/2023]
Abstract
There are few reports of the long-term efficacy of splenectomy in children with immune thrombocytopenia (ITP). In a 33-year period, we performed splenectomies in 23 pediatric patients with ITP at a single institution in Japan. The age at surgery was 5-22 years with a median of 10 years. The follow-up period was 1-141 months with a median of 48 months. Before surgery, we confirmed the presence or absence of the accessory spleen by contrast-enhanced CT scan and we recommended vaccination with pneumococcal vaccine. Four patients underwent laparotomy before 1998, and 19 patients underwent laparoscopic surgery after 1999. Splenectomy showed high efficacy with a partial response rate of 83% and a complete response rate of 74%. Complete response was maintained in 70% of patients until the end of the observation period, and 91% were able to discontinue long-term management drugs such as steroids. No serious complications such as infectious diseases were observed. Although the number of cases here was small, the long-term efficacy and safety of splenectomy makes it a viable option in pediatric ITP despite the existence of newer therapeutic agents. Further research is necessary to compare the long-term efficacy and safety of splenectomy with new therapeutic agents.
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Riaz A, Ali HT, Ali F, Ali J. Refractory immune thrombocytopenic purpura (ITP) after accessory splenectomy: A case report and literature review. Clin Hemorheol Microcirc 2023; 85:189-194. [PMID: 37599530 DOI: 10.3233/ch-231881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
Immune thrombocytopenic purpura (ITP) is an autoimmune disorder characterized by a platelet count of less than 100 x 109 /L, resulting from antibody-mediated platelet destruction. Treatment for ITP typically involves steroids, and intravenous immunoglobulins (IVIG) can be added. Splenectomy is performed in cases with refractory ITP. Rituximab can suppress immunity but has limited efficacy in ITP cases. Herein, we present a rare case of a 30-year-old female who was first diagnosed with ITP and underwent a splenectomy two years later. However, seven years after surgery, she was presented with symptoms of ITP. A splenic scan showed an accessory spleen in the spleen bed, for which she underwent accessory spleen removal surgery. Her laboratory tests three days post-operation showed a rise in platelet count and hence was discharged a few days later. The patient had recurrent attacks of ITP even after the removal of the normal and accessory spleen, suggesting that accessory spleen removal may not always be an effective treatment for ITP. The patient eventually died. While splenectomy is a common treatment for ITP, it may not always be effective in all cases, and other treatments such as bone marrow transplantation may be necessary.
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Affiliation(s)
- Asad Riaz
- Ayub Teaching Hospital, Abbottabad, Pakistan
| | | | - Fawad Ali
- Hayatabad Medical Complex, Peshawar, Pakistan
| | - Jawad Ali
- Ayub Teaching Hospital, Abbottabad, Pakistan
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Li X, Zhu W, Bao J, Li J, Zhou Y. Efficacy and safety of cyclosporine-based regimens for primary immune thrombocytopenia: a systematic review and meta-analysis. J Int Med Res 2023; 51:3000605221149870. [PMID: 36650914 PMCID: PMC9869211 DOI: 10.1177/03000605221149870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/19/2022] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To conduct a meta-analysis assessing the efficacy and safety of cyclosporine-based combinations for primary immune thrombocytopenia (ITP). METHODS Randomized controlled clinical trials were collected by systematically searching databases (PubMed®, MEDLINE®, EMBASE, The Cochrane Library, China National Knowledge Infrastructure) from inception to June 2022. All studies included patients with ITP who received cyclosporine-based regimens. We performed comprehensive analyses of the overall response rate (ORR), complete response (CR) rate, partial response (PR) rate, relapse rate, platelet count, and adverse drug reaction (ADR) rate. RESULTS Seven studies (n = 418) were ultimately included. According to a fixed-effects model, cyclosporine-based combinations improved the ORR and CR rate and reduced the relapse rate. The ADR rate was not increased in the cyclosporine-based combination group. Cyclosporine-based regimens effectively increased the platelet count. Subgroup analysis illustrated that cyclosporine-based combinations were linked to higher ORRs in both children (odds ratio [OR] = 5.74, 95% confidence interval [CI] = 1.79-18.41) and adults (OR = 5.46, 95% CI = 2.48-12.02) and a higher CR rate in adults (OR = 2.97, 95% CI = 1.56-5.63). CONCLUSION Cyclosporine exhibited efficacy in the treatment of ITP without increasing the risk of ADRs.
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Affiliation(s)
- Xiaojing Li
- The Hematological Dept., Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wenwei Zhu
- The Hematological Dept., Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jizhang Bao
- The Hematological Dept., Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai, China
| | - Jiekai Li
- The Hematological Dept., Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yongming Zhou
- The Hematological Dept., Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Fattizzo B, Cantoni S, Giannotta JA, Bandiera L, Zavaglia R, Bortolotti M, Barcellini W. Efficacy and safety of cyclosporine A treatment in autoimmune cytopenias: the experience of two Italian reference centers. Ther Adv Hematol 2022; 13:20406207221097780. [PMID: 35585968 PMCID: PMC9109490 DOI: 10.1177/20406207221097780] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 04/13/2022] [Indexed: 12/24/2022] Open
Abstract
Background: Immune thrombocytopenia (ITP) and autoimmune hemolytic anemia (AIHA) show
good responses to frontline steroids. About two-third of cases relapse and
require second-line treatment, including rituximab, mainly effective in
AIHA, and thrombopoietin-receptor agonists (TPO-RAs) in ITP, while the use
of splenectomy progressively decreased due to concerns for
infectious/thrombotic complications. For those failing second line,
immunosuppressants may be considered. Objectives: The aim of this study was to evaluate the efficacy of cyclosporine treatment
in patients with ITP and AIHA. Design: In this retrospective study, we evaluated the efficacy and safety of
cyclosporine A (CyA) in ITP (N = 29) and AIHA
(N = 10) patients followed at two reference centers in
Milan, Italy. Methods: Responses were classified as partial [Hb > 10 or at least 2 g/dl increase
from baseline, platelets (PLT) > 30 × 109/l with at least
doubling from baseline] and complete (Hb > 12 g/dl or
PLT > 100 × 109/l) and evaluated at 3, 6, and 12 months.
Treatment emergent adverse events were also registered. Results: The median time from diagnosis to CyA was 35 months (3–293), and patients had
required a median of 4 (1–8) previous therapy lines. Median duration of CyA
was 28 (2–140) months and responses were achieved in 86% of ITP and 50% of
AIHA subjects. Responders could reduce or discontinue concomitant treatment
and resolved PLT fluctuations on TPO-RA. CyA was generally well tolerated,
and only two serious infectious complications in elderly patients on
concomitant steroids suggesting caution in this patient population. Conclusion: CyA may be advisable in ITP, which is not well controlled under TPO-RA, and
in AIHA failing rituximab, particularly if ineligible in clinical trial.
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Affiliation(s)
- Bruno Fattizzo
- Hematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan, via F. Sforza 35, 20100 Milan, Italy
| | - Silvia Cantoni
- Hematology Unit, Hematology & Oncology Department, Niguarda Cancer Center, ASST Ospedale Niguarda, Milan, Italy
| | | | - Laura Bandiera
- Pathology Unit, Hematology & Oncology Department, Niguarda Cancer Center, ASST Ospedale Niguarda, Milan, Italy
| | - Rachele Zavaglia
- Department of Oncology and Hemato-Oncologyilan, University of Milan, Italy
| | - Marta Bortolotti
- Department of Oncology and Hemato-Oncologyilan, University of Milan, Italy
| | - Wilma Barcellini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan, Milan, Italy
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Xu L, Zhang Y, Lin N, Song X, Dai Q. Eltrombopag improves refractory thrombocytopenia in patients with Sjögren's syndrome. Sci Prog 2022; 105:368504221102786. [PMID: 35603866 PMCID: PMC10306133 DOI: 10.1177/00368504221102786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Eltrombopag, a kind of thrombopoietin (TPO) receptor agonist, plays the role on the megakaryocyte to activate the platelet production and rapidly increase the number of circulating platelets in patients with primary immune thrombocytopenia (ITP). Eltrombopag provides an opportunity for rapid tapering and/or cessation of corticosteroid therapy. However, it is not clear about the platelet response to Eltrombopag in ITP associated with Sjögren's Syndrome(SS). METHODS A retrospective research was conducted on the clinical course of three patients, each with ITP secondary to SS, and initially received therapy of corticosteroids or other immunomodulatory. They took this drug for bleeding diseases. Referring to the description, Eltrombopag was prescribed and adjusted with an initial dose of 25 mg daily, then weekly, then monthly according to the monitoring of platelet counts. RESULTS All patients maintained a satisfactory level of platelet counts (>100,000/mm3 for >2 years) following corticosteroid withdrawal. Meanwhile, Eltrombopag was well-tolerated, and there were no adverse effects, such as thrombotic events. CONCLUSIONS Eltrombopag is effective and safe for patients with ITP associated with SS during corticosteroid withdrawal. Thus it may be a crucial therapeutic strategy for reducing corticosteroid-related side effects in SS patients with ITP.
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Affiliation(s)
- Liping Xu
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Zhejiang Chinese
Medical University, Hangzhou, China
| | - Yan Zhang
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Zhejiang Chinese
Medical University, Hangzhou, China
| | - Na Lin
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Zhejiang Chinese
Medical University, Hangzhou, China
| | - Xinwei Song
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Zhejiang Chinese
Medical University, Hangzhou, China
| | - Qiaoding Dai
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Zhejiang Chinese
Medical University, Hangzhou, China
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