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

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

Hemorrhage ; Humans ; Purpura, Thrombocytopenic, Idiopathic ; diagnosis

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

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

A 34-year-old male presented with fluctuating diplopia, ptosis and motor weakness, who had been suffering from idiopathic thrombocytopenic purpura (ITP) and non-small cell lung cancer (NSCLC). Clinical and laboratory findings confirmed the diagnosis of generalized myasthenia gravis (MG). MG was successfully managed with pharmacologic treatments including an immunosuppressive agent. To the best of our knowledge, this is the first case of MG combined with ITP and NSCLC.
Adult ; Carcinoma, Non-Small-Cell Lung* ; Diagnosis ; Diplopia ; Humans ; Male ; Myasthenia Gravis* ; Purpura, Thrombocytopenic, Idiopathic*

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: Mean platelet volume(MPV) and platelet distribution width(PDW) are useful parameters in evaluating disorders of platelets. In cases with idiopathic thrombocytopenic purpura(ITP), they change as platelet count increases. In this study, we compared the values of MPV and PDW in ITP patients at diagnosis with those of normal children. We also studied whether the early changes in MPV may predict the clinical course. METHODS: From December 1995 to May 2001, 71 patients with ITP were admitted to Ajou University Hospital. They were treated with IVIg 400 mg/kg for five days and MPV, PDW, platelet count were analysed. Normal control group(n=38) was compared. The study group was divided into acute and chronic forms, and also divided into group A, good early responders whose platelets increased more than 100,000/microL within 5 days and group B who did not. RESULTS: Mean value of MPV at diagnosis in ITP patients was lower than the normal control group(P<0.05). In group A, MPV was abruptly increased on the first day after IVIg and then started to decrease. But in group B, MPV was steadily increased until the fourth day after IVIg. In the normal control group, there were inverse correlations between platelet count and MPV(r= -0.415, P<0.05), but in ITP patients, there were positive relationships between platelet count and MPV(r=0.646, P<0.05) at diagnosis. CONCLUSIONS: MPV at diagnosis of ITP was lower than the normal control. MPV and PDW could not predict the course of ITP patients, but MPV could distinguish good early responders. More research is needed to find out the reasons of decreased MPV at diagnosis of ITP.
Blood Platelets* ; Child ; Diagnosis ; Humans ; Immunoglobulins, Intravenous ; Mean Platelet Volume* ; Platelet Count ; Purpura, Thrombocytopenic, Idiopathic*