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Caseiro Alves ME, Carmo F, Malato M, Cunha F. Immune thrombocytopenia in the setting of acute SARS-CoV-2 infection. BMJ Case Rep 2023; 16:e254352. [PMID: 37385718 DOI: 10.1136/bcr-2022-254352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023] Open
Abstract
Immune thrombocytopenia (ITP) is an immune-mediated event, characterised by the destruction of platelets by autoantibodies resulting in isolated thrombocytopaenia (platelets <100 x109/L). In children, most cases are preceded by a viral infection. Cases of ITP in the setting of SARS-CoV-2 infection have been described. We describe a previously healthy boy, who presented with an extensive frontal and periorbital haematoma, petechial rash on the trunk and coryza. He had suffered a minor head trauma, 9 days before admission. Blood tests revealed a platelet count of 8000/µL. The remainder study was unremarkable, except for a positive SARS-CoV-2 PCR. Treatment comprised a single dose of intravenous immunoglobulin, with increase in platelet count and no recurrence. We made a working diagnosis of an ITP concurrent with a SARS-CoV-2 infection. Although few cases have been described, SARS-CoV-2 might be considered as a trigger for ITP.
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Affiliation(s)
- M Eduarda Caseiro Alves
- Pediatria Médica, Centro Hospitalar e Universitário de Lisboa Central E.P.E, Hospital de Dona Estefânia, Lisboa, Portugal
| | - Filipa Carmo
- Pediatria, Centro Hospitalar e Universitário de Lisboa Norte, E P E, Lisboa, Portugal
| | - Madalena Malato
- Pediatria Geral, Hospital de Vila Franca de Xira, E P E, Vila Franca de Xira, Portugal
| | - Florbela Cunha
- Pediatria Geral, Hospital de Vila Franca de Xira, E P E, Vila Franca de Xira, Portugal
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Sakong MG, Park JH, Son SB, Kim YK, Lee JM. IVIG Treatment Response and Age are Important for the Prognosis of Pediatric Immune Thrombocytopenia. CLINICAL PEDIATRIC HEMATOLOGY-ONCOLOGY 2022. [DOI: 10.15264/cpho.2022.29.2.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Min Gi Sakong
- Department of Medicine, College of Medicine, Yeungnam University, Daegu, Korea
| | - Ji Hoon Park
- Department of Medicine, College of Medicine, Yeungnam University, Daegu, Korea
| | - Sang Beom Son
- Department of Medicine, College of Medicine, Yeungnam University, Daegu, Korea
| | - Yu Kyung Kim
- Department of Clinical Pathology, School of Medicine, Kyungpook National University, 3Department of Pediatrics, College of Medicine, Yeungnam University, Daegu, Korea
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Ringoringo HP. Immune Thrombocytopenia as the Initial Manifestation of Pediatric Systemic Lupus Erythematosus: Case Reports. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Immune thrombocytopenia (ITP) can precede the onset of systemic lupus erythematosus (SLE) by months to years.
CASE PRESENTATION: A 12-year-old girl weighing 46 kg came to the hospital with the complaint of 12 days-menstrual bleeding. The patient is weak, pale. Eyes, ENT, heart, lungs, abdomen: within normal limits, no petechiae. Laboratorium: Hemoglobin (Hb) 4.6 g/dL, leukocytes 12,930/uL, platelets 11,000/uL, hematocrit 15%, Diff Count: normal. Red blood cell (RBC) 1.59 million/uL, mean corpuscular volume (MCV) 94.3fL, mean corpuscular hemoglobin (MCH) 28.9pg, MCH concentration 30.7%, RDW-CV 14.6%. Corrected-reticulocytes 5.16%, Ret-He 22.6, IPF 54.17%. Peripheral blood smears normochromic, normocytic, blast not found, platelets are rare. The diagnosis is menometrorrhagia with anemia due to bleeding caused by ITP. The patient was given PRC and platelet transfusion, methylprednisolone. Three months later, the patient had another prolonged menstruation, hair loss, no petechiae, or purpura. Laboratorium: Hb 8.2 g/dL, leukocytes 7800/uL, platelets 6000/uL, RBC 1.59 million/uL, MCV 94.3fL, MCH 28.9pg, corrected reticulocytes 5.08%, Ret-He 24.6, IPF 54.5%. ANA test positive, Anti dsDNA-NcX 190.2 IU/ml. The diagnosis is SLE. During the last 16 months, the patient took 10 mg prednisone with a platelet count >150,000/uL.
CONCLUSION: In every case of ITP in a child, consider the possibility of SLE.
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Ringoringo HP, Hartoyo E. Megadose Methylprednisolone for Immune Thrombocytopenia in an Infant Positive for SARS-CoV-2: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e931517. [PMID: 34471086 PMCID: PMC8422568 DOI: 10.12659/ajcr.931517] [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] [Indexed: 11/16/2022]
Abstract
Patient: Male, 9-month-old
Final Diagnosis: Newly diagnosed ITP
Symptoms: Petechiae on the forehead • cheeks • mouth • extremities. The patient is febrile, had rhinorrhea for three days previously. The patient is pale, weak, cannot drink
Medication: —
Clinical Procedure: The patient had immunizations of the Measles-Rubella vaccine 19 days before. Physical examination: Eye, ENT, and mouth, no abnormalities. Heart and Lungs within normal limits. Abdomen: there was no organomegaly – there neither lymphadenopathy nor a congenital anomaly
Specialty: Hematology • Infectious Diseases • Pediatrics and Neonatology
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Affiliation(s)
- Harapan Parlindungan Ringoringo
- Department of Pediatrics, Faculty of Medicine, Lambung Mangkurat University, RSD Idaman Banjarbaru, Banjarbaru, South Kalimantan, Indonesia
| | - Edi Hartoyo
- Department of Pediatrics, Faculty of Medicine, Lambung Mangkurat University, Ulin General Hospital, Banjarmasin, South Kalimantan, Indonesia
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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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Sun Y, Long S, Liu W. Risk Factors and Psychological Analysis of Chronic Immune Thrombocytopenia in Children. Int J Gen Med 2021; 13:1675-1683. [PMID: 33408505 PMCID: PMC7779312 DOI: 10.2147/ijgm.s290459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 12/14/2020] [Indexed: 11/23/2022] Open
Abstract
Objective To study the risk factors and psychological changes in children with chronic immune thrombocytopenia (CITP). Methods This was a retrospective analysis of 234 children with ITP diagnosed and treated in the Affiliated Hospital of Southwest Medical University from January 2016 to December 2018. The clinical characteristics and related laboratory factors of all patients were collected, and their impact on the chronicity of ITP was analyzed. The Eysenck Personality Questionnaire-Children’s Version (7–15 years old) is a psychological assessment of children with chronic ITP (CITP). Results Univariate analysis found that the course of the initial diagnosis (χ2 =6.879, P<0.05), the age of onset (χ2 =13.846, P<0.05) and the absolute value of the initial diagnosis of peripheral blood lymphocytes (χ2 =6.436, P<0.05) had statistical differences in the chronicity of ITP in children; a multivariate analysis of the course of the first diagnosis, the age of onset and absolute lymphocyte count (ALC) revealed that ALC is an independent factor in children’s chronic ITP (P<0.05). Compared with normal children, children with CITP had statistical significance in extraversion (t=−3.476, P<0.05); compared with newly diagnosed children, they had statistical significance in extraversion (E) and lying (L) (P<0.05); and there was no statistical difference compared with persistent children (P>0.05). Conclusion The age of onset, the absolute value of lymphocytes at the initial diagnosis, and the course of the initial diagnosis are important for predicting the chronicity of ITP in children. ALC is an independent predictor; children with chronic ITP have psychological problems.
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Affiliation(s)
- Ying Sun
- Department of Pediatrics, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China
| | - Sili Long
- Department of Pediatrics, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China
| | - Wenjun Liu
- Department of Pediatrics, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China
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Zhou Z, Gao Y, Li X, Ren J, Liu Y, Li J. The clinical characteristics of patients with acute leukemia or stem cell transplantation exhibiting immune based platelet refractoriness. Transfus Apher Sci 2020; 59:102725. [PMID: 31974031 DOI: 10.1016/j.transci.2020.102725] [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: 10/21/2019] [Revised: 12/01/2019] [Accepted: 12/23/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND To investigate the related factors influencing immune platelet transfusion refractoriness (PTR) in acute leukemia (AL) from induction to consolidation and compare management for immune PTR, so as to improve the Platelet increment in AL. METHODS The primary analysis included 890 patients with AL, 225 of whom were the immune PTR (25 %).They are patients in our center from induction to consolidation or transplantation in the past 10 years. Flow cytometry, karyotype characteristics and other basic information were compared between the immune PTR vs control (no-PTR) groups. We analyzed the treatment outcomes of immune PTR including matched platelets, intravenous immunoglobulin (IVIG), increasing apheresis platelet does. RESULTS Immune PTR is more likely to occur in patients with poor prognosis in acute lymphoblastic leukemia (ALL) (P = 0.01).There is a relation between NPM1 mutation and occurrence of immune PTR (P = 0.029).The incidence of PTR at 35-59Y was higher than that at <35Y(OR = 0.68, 95 % CI = 0.48-0.96) and ≥60Y(OR = 0.49,95 % CI = 0.28-0.83), and the difference was statistically significant(P = 0.03, P = 0.01).The Platelet increment with 1 unit (u) was 47.12 %, 2 u increased to 71.14 %, and the matched 2 u (75.11 %) had the best effect. IVIG improved the Platelet increment, but there was no difference between 0.4 g/kg IVIG and 1 g/kg IVIG. Immune PTR is more likely to occur in the ages of 35-60 years. CONCLUSION There are specific AL patient characteristics which predispose to the phenomenon of immune based PTR. Meanwhile, increasing the IVIG dose could not improve Platelet increment obviously.
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Affiliation(s)
- Zhenhai Zhou
- Department of Hematology, The First Affiliated Hospital, Sun Yat-sen University, 58 zhongshan er ave, Guangzhou, China.
| | - Yixin Gao
- Department of Blood Transfusion, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaoyin Li
- Department of Radiology Intervention, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jun Ren
- Department of Blood Transfusion, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yuxuan Liu
- Department of Hematology, The First Affiliated Hospital, Sun Yat-sen University, 58 zhongshan er ave, Guangzhou, China
| | - Juan Li
- Department of Hematology, The First Affiliated Hospital, Sun Yat-sen University, 58 zhongshan er ave, Guangzhou, China
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Song J, Chen C, Wang Q, Wang LH, Cao J, Guo PX. Platelet-to-Lymphocyte Ratio (PLR) Is Associated with Immune Thrombocytopenia (ITP) Recurrence: A Retrospective Cohort Study. Med Sci Monit 2019; 25:8683-8693. [PMID: 31735908 PMCID: PMC6880641 DOI: 10.12659/msm.917531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Current guidelines are inadequate for use in predicting ITP recurrence. Therefore, our primary goal in this study was to investigate the association of platelet-to-lymphocyte ratio (PLR) at diagnosis with ITP recurrence in Chinese patients. MATERIAL AND METHODS We performed a historical cohort study and non-selectively enrolled 233 patients with newly-identified ITP from March 2013 to June 2017. The independent variable was PLR recorded at diagnosis and the dependent variable was recurrence-free survival (RFS) at 6 months. Data on the following variables were also collected for establishing a multivariate Cox regression model: demographic details, general details, and variables found to be closely related to PLR in previous studies, as well as risk factors for ITP recurrence. RESULTS During follow-up, 85 patients had an event within 6 months. At the range of 0.86-9.7 of PLR, a 1-unit increase in PLR was associated with a 13% decrease in ITP recurrence (hazard ratio: 0.87; 95% confidence interval: 0.78-0.97), whereas no association was detected at the range of 9.7-33.75 of PLR (hazard ratio: 0.99; 95% confidence interval: 0.95-1.04). An interaction test indicated that patients with HP infection (0.91 (0.86-1.97)) or diabetes history (0.86 (0.78-0.96)) showed a stronger association compared with patients without HP infection (1.01 (0.95-1.04) and those without diabetes (1.01 (0.97-1.04)). CONCLUSIONS Our findings suggest that PLR is a useful parameter to consider when hematologists attempt to assess the risk of recurrence in ITP patients receiving first-line therapy, and the nonlinearity of PLR and ITP recurrence risk must be fully considered when constructing predictive models.
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Affiliation(s)
- Jun Song
- Department of Hematology, The People's Hospital of Guizhou Province, Guiyang, Guizhou, China (mainland)
| | - Chi Chen
- Department of Immunology and Microbiology, Guizhou University of Traditional Chinese Medicine, Guiyang, Guizhou, China (mainland)
| | - Qing Wang
- Department of Hematology, The People's Hospital of Guizhou Province, Guiyang, Guizhou, China (mainland)
| | - Lin-Hui Wang
- Department of Hematology, The People's Hospital of Guizhou Province, Guiyang, Guizhou, China (mainland)
| | - Jun Cao
- Department of Hematology, The People's Hospital of Guizhou Province, Guiyang, Guizhou, China (mainland)
| | - Peng-Xiang Guo
- Department of Hematology, The People's Hospital of Guizhou Province, Guiyang, Guizhou, China (mainland)
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Cutaneous Hemorrhage Types as Supportive Factors for Predicting Chronic Immune Thrombocytopenia in Children. J Pediatr Hematol Oncol 2018; 40:337-340. [PMID: 29668541 DOI: 10.1097/mph.0000000000001167] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Our objective was to assess risk factors for developing chronic immune thrombocytopenia (ITP) in children. The charts of all consecutive children diagnosed with ITP between 2000 and 2015 at a single center were retrospectively reviewed, and clinical characteristics at initial presentation were analyzed. Sixty-two children were included in the study (mean age, 6.15 y); 44 (71%) were found to have acute ITP, and 18 (29%) developed chronic ITP (permanent or relapsing thrombocytopenia >12 mo). In a univariate analysis, cutaneous hemorrhages were observed significantly more in acute patients (90.9%) than in chronic patients (61.1%). Patients who had acute ITP were more likely to present with a combination of petechiae, purpura, and/or ecchymosis (75%) than patients with chronic disease (44.4%, P=0.010). In multivariate analysis, older age increased the risk (odds ratio=1.1; P<0.05) for chronic disease, and manifestations of combination skin hemorrhages (petechiae/purpura/ecchymosis) reduced the risk (odds ratio=0.167; P<0.05). In conclusion, the most important risk factor for chronic disease is older age. Skin hemorrhage types were found to be a supportive factor for the prediction process: the combination of petechia/purpura/ecchymosis was associated with a lower risk for developing chronic disease compared with petechiae alone. Future studies should assess the prognostic value of skin hemorrhage types that are a simple way to predict the course of ITP in children.
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Jang JH, Kim JY, Mun YC, Bang SM, Lim YJ, Shin DY, Choi YB, Yhim HY, Lee JW, Kook H. Management of immune thrombocytopenia: Korean experts recommendation in 2017. Blood Res 2017; 52:254-263. [PMID: 29333401 PMCID: PMC5762735 DOI: 10.5045/br.2017.52.4.254] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 12/03/2017] [Accepted: 12/13/2017] [Indexed: 12/31/2022] Open
Abstract
Management options for patients with immune thrombocytopenia (ITP) have evolved substantially over the past decades. The American Society of Hematology published a treatment guideline for clinicians referring to the management of ITP in 2011. This evidence-based practice guideline for ITP enables the appropriate treatment of a larger proportion of patients and the maintenance of normal platelet counts. Korean authority operates a unified mandatory national health insurance system. Even though we have a uniform standard guideline enforced by insurance reimbursement, there are several unsolved issues in real practice in ITP treatment. To optimize the management of Korean ITP patients, the Korean Society of Hematology Aplastic Anemia Working Party (KSHAAWP) reviewed the consensus and the Korean data on the clinical practices of ITP therapy. Here, we report a Korean expert recommendation guide for the management of ITP.
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Affiliation(s)
- Jun Ho Jang
- Department of Hematology-Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Yoon Kim
- Department of Pediatrics, Kyungpook National University School of Medicine, Daegu, Korea
| | - Yeung-Chul Mun
- Department of Internal Medicine, Ewha Womans' University School of Medicine, Seoul, Korea
| | - Soo-Mee Bang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yeon Jung Lim
- Department of Pediatrics, Chungnam National University School of Medicine, Daejeon, Korea
| | - Dong-Yeop Shin
- Department of Internal Medicine, Seoul National University Hospital, Korea
| | - Young Bae Choi
- Department of Pediatrics, Chung-Ang University Hospital, Seoul, Korea
| | - Ho-Young Yhim
- Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea
| | - Jong Wook Lee
- Department of Hematology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hoon Kook
- Department of Pediatrics, Chonnam National University Hwasun Hospital, Hwasun, Korea
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