Document Detail


Major hemorrhage in children with idiopathic thrombocytopenic purpura: immediate response to therapy and long-term outcome.
MedLine Citation:
PMID:  9738712     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: We retrospectively characterized children with idiopathic thrombocytopenic purpura (ITP) who had major hemorrhage to determine response to therapy and long-term outcome. STUDY DESIGN: We reviewed the medical records of 332 children with ITP diagnosed at our center during the last 10 years for occurrence of major hemorrhage, defined as (1) intracranial hemorrhage, (2) epistaxis requiring cautery or nasal packing, (3) gross hematuria, or (4) other bleeding causing a decline in hemoglobin concentration. RESULTS: Of 332 patients with ITP, 58 (17%) had 68 episodes of major hemorrhage; 56 of these episodes were treated with corticosteroids, intravenous immunoglobulin, or both. The platelet count rose to > or =20,000/mm3 within 24 hours after presentation after only 18% of evaluated events, and 28% of patients with major hemorrhage still had a platelet count <20,000/mm3 after 7 days. Twenty-seven of 49 patients available for evaluation had resolution of ITP within 6 months, 21 had chronic ITP, and 1 died of sepsis. CONCLUSIONS: We observed that 17% of children with ITP had major hemorrhage. Only a minority of these patients had an immediate rise in platelet count after receiving intravenous immunoglobulin, corticosteroid treatment, or both. Prospective studies of childhood ITP focusing on short-term outcome variables in addition to platelet count should be performed to better define optimal treatment for each affected child.
Authors:
D Medeiros; G R Buchanan
Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  The Journal of pediatrics     Volume:  133     ISSN:  0022-3476     ISO Abbreviation:  J. Pediatr.     Publication Date:  1998 Sep 
Date Detail:
Created Date:  1998-10-01     Completed Date:  1998-10-01     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0375410     Medline TA:  J Pediatr     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  334-9     Citation Subset:  AIM; IM    
Affiliation:
Department of Pediatrics, The University of Texas Southwestern Medical Center at Dallas and the Center for Cancer and Blood Disorders, 75235-9063, USA.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adrenal Cortex Hormones / therapeutic use
Cause of Death
Cautery
Cerebral Hemorrhage / etiology,  physiopathology,  therapy
Child
Child, Preschool
Chronic Disease
Epistaxis / etiology,  physiopathology,  therapy
Female
Follow-Up Studies
Hematuria / etiology,  physiopathology,  therapy
Hemoglobins / analysis
Hemorrhage / blood,  etiology*,  physiopathology,  therapy
Humans
Immunoglobulins, Intravenous / therapeutic use
Infant
Male
Platelet Count
Prospective Studies
Purpura, Thrombocytopenic, Idiopathic / blood,  complications*,  physiopathology,  therapy
Remission Induction
Retrospective Studies
Sepsis / etiology
Tampons, Surgical
Treatment Outcome
Grant Support
ID/Acronym/Agency:
CA09640/CA/NCI NIH HHS
Chemical
Reg. No./Substance:
0/Adrenal Cortex Hormones; 0/Hemoglobins; 0/Immunoglobulins, Intravenous
Comments/Corrections
Comment In:
J Pediatr. 1998 Sep;133(3):313-4   [PMID:  9738705 ]

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