The diversity of diagnostic criteria of idiopathic thrombocytopenic purpura (ITP) makes it difficult to compare clinical trial results and exchange clinical experiences. To address this issue, an ITP international working group convened a consensus conference in Italy in October 2007, and some new consensus concerning the terminology, definition, phases, grading of severity, prognosis, and treatment were achieved. The treatment of ITP has been dramatically improved along with the introduction of novel therapeutic agents. Rituximab, a monoclonal anti-CD20 antibody that is able to deplete autoantibody-producing B lymphocytes, has been widely applied because of its high efficacy and safety. Recent evidences suggest that decreased platelet production may also contribute to the development of ITP. Therefore, novel thrombopoiesis-stimulating agents such as thrombopoietin-receptor agonists Romiplostim and Eltrombopag have become new therapeutic options for ITP.
Humans ; Purpura, Thrombocytopenic, Idiopathic ; diagnosis ; therapy

Adult ; Humans ; Purpura, Thrombocytopenic, Idiopathic ; diagnosis ; therapy

Hemorrhage ; Humans ; Purpura, Thrombocytopenic, Idiopathic ; diagnosis

The study of 183 idiopathic thrombocytopenic purpura children treat at Hai Phong Children Hospital from 1/1998 to 4/2003. The disease is frequent in small children from 1 month to 5 years old in spring and winter, sex ratio is similar. Main manifestations were 95.6% spontaneous hemorrhage, fang hemorrhage 32%, nasal hemorrhage 12%. Polymorphic hemorrhage 60.44%, mild hemorrhage 55.7%. Main hematological sign was thrombocytopenia but it was not severe. Bleeding time was above 10 minutes in most of cases (57.38%). There were a correlation between platelet count and bleeding time
Diagnosis ; Hematology ; Purpura, Thrombocytopenic, Idiopathic ; Child

Immune thrombocytopenia (ITP) is the most common cause of thrombocytopenia in children and can be defined as an autoimmune disorder of isolated thrombocytopenia without other causes of thrombocytopenia. This review will focus on the diagnostic approach of ITP, especially regarding the differential diagnosis. The practice of differential diagnosis has the goal of distinguishing primary ITP from secondary ITP and nonimmune thrombocytopenia requiring different treatments and showing different prognoses.
Child ; Diagnosis ; Diagnosis, Differential ; Humans ; Prognosis ; Purpura, Thrombocytopenic, Idiopathic* ; Thrombocytopenia

PURPOSE: It is well known that use of intranenous methylprednisolone(IVMP)for the patients with idiopathic thrombocytopenic purpura(ITP) is not only as effective as use of intravenous gammaglobulin to mincrease platelets quickly, but also the former is less expensive than the latter. As the adequate dosage of IVMP has not been fully elucidated, we have tried to determine it. METHODS: The subjects were 35 childhood patients below 15 years of age, who were diagnosed with ITP for the first time and whose platelet count was less than 20,000/mm(3) at diagnosis. We divided them into three groups : Group A included 8 cases with IVMP dosage of 5mg/kg/day, Group B included 9 patients with IVMP dosage of 10mg/kg/day, and group C included 18 patients with IVMP dosage of 20mg/kg/day. We checked the platelet count every day after IVMP administration daily for 5 days and also observed for side effects if any. RESULTS: After IVMP administration, we obseved increasing tendency of platelets in all three groups, of which group C was more rapid and higher in increasing platelets than the other groups(p<0.05). After IVMP therapy for 5 days, cases with platelets>20,000/mm(3) were 6(75%) in group A, 7(78%) in group B, and 18(100%) in group C. Cases with platelets >50,000/mm(3) were 5(63%), 6(67%), 17(94%) in groups A, B, C, respectively, and cases with platelets> 100,000/mm(3) were 3(38%), 5(56%), 14(78%), in group A, B, C, respectively. And there were no remarkable side effects except a case of transient hypertensive headache in group C. CONCLUSIONS: We concluded that the effectiveness of IVMP therapy for increasing platelets was more rapid and higher in group C than in group A or B, and side effect was minimal.
Child* ; Diagnosis ; Headache ; Humans ; Methylprednisolone* ; Platelet Count ; Purpura, Thrombocytopenic, Idiopathic*

Adult ; Female ; Humans ; Lymphoma, Non-Hodgkin ; diagnosis ; Pregnancy ; Pregnancy Complications ; diagnosis ; Purpura, Thrombocytopenic, Idiopathic ; diagnosis

PURPOSE: In chronic idiopathic thrombocytopenic purpura (ITP), primary treatment is steroid therapy. However treatment with steroids effects a complete response in less than 30% of the patients whereas a splenectomy is successful in more than 60% of the patients who undergo it. The minimal access afforded by a laparoscopic splenectomy (LS) is considered highly desirable for these patients. The purpose of this study was to compare the clinical benefits of a LS with those of conventional open surgery (OS) for patients with ITP. METHODS: The results of 12 subsequent laparoscopic splenectomies performed from December 1996 to May 1998 were compared with those of 10 open splenectomies performed from September 1987 to May 1995. The indications of a splenectomy were medical intractability, recurrent ITP and/or complications of steroids. The operative time, the time to resumption of oral intake, the postoperative hospital stay, the platelet count, the postoperative response rate, the incidence of accessory spleen, and the period of complication after preoperative steroid administration were statistically analyzed (t-test, chi-square test). Also, the timing of the splenectomy was compared. RESULTS: The operative time was longer in the LS patients (LS 221 min, OS 127 min, p=0.0033), but the length of stay (LS 9.3+/-3.87 days, OS 4.6+/-1.92 days, p=0.0033) and duration of ileus (LS 2.9+/-0.32 days, OS 1.9+/-0.90 days, p=0.0002) were shorter in the LS group. There were no significant differences in platelet count, postopertative response rate, and incidence of accessory spleen between the two groups. Accessory spleens were found in 4 patients (18%). The conversion rate was 17% (only 2 initial cases). The splenectomy had been chosen as a second-line treatment in 91.7% and 60% of the LS and OS patients, respectively, and as a third-line treatment in 8.3% and 40% of those patients, but these result have no statistical significance. The time interval between diagnosis and operation also was not significantly different, between the two groups. CONCLUSION: A LS is safe and effective for the management of ITP and allowsrapid recovery. A LS should be the early treatment of choice for patients, who do not response to primary steroid therapy or who have recurrent or complicated ITP. When such patients are managed early surgical laparoscopic treatment, the side effects of steroid may be minimized.
Diagnosis ; Humans ; Ileus ; Incidence ; Length of Stay ; Operative Time ; Platelet Count ; Purpura, Thrombocytopenic, Idiopathic* ; Spleen ; Splenectomy* ; Steroids

PURPOSE: The age-related clinical expression of acute idiopathic thrombocytopenic purpura (acute ITP) in children is unclear. In particular, information about acute ITP during the first year of life is limited. To find several features distinguishing infants from older children with acute ITP. We evaluated the clinical features, laboratory data, treatment outcomes of childhood acute ITP. METHODS: We retrospectively analysed the data of newly diagnosed 61 children with acute ITP at Pusan National University Hospital between January 1999 and December 2003. RESULTS: The mean age at the diagnosis of childhood acute ITP in our study was 4.7+/-3.9 years of age. In the age groups less than 1, 1~10 and older 10 years there were 14 (23.0%), 37 (60.6%), 10 (16.4%) cases, respectively. Male to female ratio was 1.6 : 1. The mean platelet count at the diagnosis of acute ITP in infants was significantly lower compared to the older age groups (P=0.001). Infants responded favorably to initial intravenous immunoglobulin treatment compared to the older age groups (P < 0.05). In infants, platelet count began to rise rapidly after initial intravenous immunoglobulin treatment. Among the 61 cases who were followed up over 6 months, 14 cases (23.0%) progressed to chronic ITP. Chronic ITP was seen significantly less frequently in infants (7.4%) than other age groups (P < 0.05). CONCLUSION: Infants with acute ITP tend to respond favorably to initial intravenous immunoglobulin treatment. Also, they are less likely to develop chronic ITP compared to the older children.
Busan ; Child* ; Diagnosis ; Female ; Humans ; Immunoglobulins ; Infant* ; Male ; Platelet Count ; Purpura, Thrombocytopenic, Idiopathic* ; Retrospective Studies

Myasthenia gravis has been associated with a variety of autoimmune diseases, but the association of myasthenia gravis with idiopathic thrombocytopenic purpura has been rarely reported. A previously healthy 33-year-old female presented with a 10-month history of easy fatigability, motor weakness, diplopia and menorrhage. Clinical and labora-tory findings supported the diagnosis of myasthenia gravis and idiopathic thrombocytopenic purpura. After a thymecto-my, there were surprising improvements not only in muscle strength, but also of thrombocytopenia. Though this associ ?ation may be incidental, the patient's progress suggests that idiopathic thrombocytopenic purpura may be closely relat-ed to myasthenia gravis immunologically because both diseases developed simultaneously and showed good therapeu-tic responses after a thymectomy.
Adult ; Autoimmune Diseases ; Diagnosis ; Diplopia ; Female ; Humans ; Muscle Strength ; Myasthenia Gravis* ; Purpura, Thrombocytopenic, Idiopathic* ; Thrombocytopenia ; Thymectomy