Seminars in Hematology
Volume 37, Issue 3 , Pages 299-314 , July 2000

Approach to the investigation and management of immune thrombocytopenic purpura in children

  • Victor Blanchette

      Affiliations

    • Corresponding Author InformationAddress reprint requests to Victor Blanchette, FRCP, Division of Hematolagy/Oncology, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario M5G 1X8, Canada.
    • ,
  • Manuel Carcao

References 

  1. Ahn YS, Byrnes JJ, Harrington WJ, et al.  The treatment of idiopathic thrombocytopenia with vinblastine-loaded platelets. N Engl J Med. 1978;298:1101–1107
  2. Ahn YS, Harrington WJ, Mylvaganam R, et al.  Slow infusion of vinca alkaloids in the treatment of idiopathic thrombocytopenic purpura. Ann Intern Med. 1984;100:192–196
  3. Albayrak D, Islek I, Kalayci AG, et al.  Acute immune thrombocytopenic purpura: A comparative study of very high oral doses of methylprednisolone and intravenously administered immune globulin. J Pediatr. 1994;125:1004–1007
  4. Ambriz P, Muñóz R, Quintanar E, et al.  Accessory spleen compromising response to splenectomy for idiopathic thrombocytopenic purpura. Radiology. 1985;155:793–795
  5. Andersen JC. Response of resistant idiopathic thrombocytopenic purpura to pulsed high-dose dexamethasone therapy. N Engl J Med. 1994;330:1560–1564
  6. Andersen JC. High-dose pulsed dexamethasone for immune thrombocytopenia. N Engl J Med. 1997;337:426–427
  7. Andrew M, Blanchette VS, Adams M, et al.  A multicenter study of the treatment of childhood chronic idiopathic thrombocytopenic purpura with anti-D. J Pediatr. 1992;120:522–527
  8. Ballem PJ, Segal GM, Stratton JR, et al.  Mechanisms of thrombocytopenia in chronic autoimmune thrombocytopenic purpura. Evidence of both impaired platelet production and increased platelet clearance. J Clin Invest. 1987;80:33–40
  9. Ballin A, Andrew M, Ling E, et al.  High-dose intravenous gammaglobulin therapy for neonatal autoimmune thrombo-cytopenia. J Pediatr. 1988;112:789–792
  10. Beardsley DS. Oral dexamethasone for chronic immune thrombocytopenic purpura: home run or base hit?. J Pediatr. 1997;130:1–2
  11. Berchtold P, McMillan R, Tani P, et al.  Autoantibodies against platelet membrane glycoproteins in children with acute and chronic immune thrombocytopenic purpura. Blood. 1989;74:1600–1602
  12. Berchtold P, McMillan R. Therapy of chronic idiopathic thrombocytopenic purpura in adults. Blood. 1989;74:2309–2317
  13. Blanchette VS. High-dose intravenous immunoglobulin therapy in childhood acute idiopathic thrombocytopenic purpura. In:  Waters AH,  Webster ADB editor. Royal Society of Medicine International Congress and Symposium Series. Intravenous Immunoglobins in Immunodeficiency Syndromes and Idiopathic Thrombocytopenic Purpura. London, England: The Royal Society of Medicine; 1985;p. 71–80
  14. Blanchette VS, Kirby MA, Turner C. Role of intravenous immunoglobulin G in autoimmune hematologic disorders. In: Semin Hematol. 29:1992;p. 72–82
  15. Blanchette VS, Luke B, Andrew M, et al.  A prospective, randomized trial of high-dose intravenous immune globulin G therapy, oral prednisone therapy, and no therapy in childhood acute immune thrombocytopenic purpura. J Pediatr. 1993;123:989–995
  16. Blanchette V, Imbach P, Andrew M, et al.  Randomised trial of intravenous immunoglobulin G, intravenous anti-D, and oral prednisone in childhood acute immune thrombocytopenic purpura. Lancet. 1994;344:703–707
  17. Blanchette V, Freedman J, Garvey B. Management of chronic immune thrombocytopenic purpura in children and adults. In: Sem Hematol. 35:1998;p. 36–51 (suppl 1)
  18. Bode C, Koerholz D, Janssen G, et al.  Poor response to pulsed high-dose dexamethasone therapy in children with resistant immune thrombocytopenic purpura. Eur J Pediatr. 1996;155:917
  19. Bolton-Maggs PHB, Moon I. Assessment of UK practice for management of acute childhood idiopathic thrombocytopenic purpura against published guidelines. Lancet. 1997;350:620–623
  20. Bolton-Maggs PHB. Acute idiopathic thrombocytopenic purpura—Management in childhood. Blood. 1997;89:1465
  21. Borgna-Pignatti C, Rugolotto S, Nobili B, et al.  A trial of high-dose dexamethasone therapy for chronic idiopathic thrombocytopenic purpura in childhood. J Pediatr. 1997;130:13–16
  22. Bouroncle BA, Doan CA. Treatment of refractory idiopathic thrombocytopenic purpura. JAMA. 1969;207:2049–2052
  23. Brennan MF, Rappeport JM, Moloney WC, et al.  Correlation between response to corticosteroids and splenectomy for adult idiopathic thrombocytopenic purpura. Am J Surg. 1975;129:490–492
  24. Brunt LM, Langer JC, Quasebarth MA, et al.  Comparative analysis of laparoscopic versus open splenectomy. Am J Surg. 1996;172:596–601
  25. Buchanan G, Holtkamp CA. Prednisone therapy for children with newly diagnosed idiopathic thrombocytopenic purpura. A randomized clinical trial. Am J Pediatr Hematol Oncol. 1984;6:355–361
  26. Buchanan GR, Feig SA, Gilchrist GS, et al.  Acute idiopathic thrombocytopenic purpura—Management in childhood. Blood. 1997;89:1464–1465
  27. Burrows RF, Kelton JG. Low fetal risks in pregnancies associated with idiopathic thrombocytopenic purpura. Am J Obstet Gynecol. 1990;163:1147–1150
  28. Burrows RF, Kelton JG. Pregnancy in patients with idiopathic thrombocytopenic purpura: Assessing the risks for the infant at delivery. Obstet Gynecol Surv. 1993;48:781–788
  29. Bussel JB, Goldman A, Imbach P, et al.  Treatment of acute idiopathic thrombocytopenia of childhood with intravenous infusions of gammaglobulin. J Pediatr. 1985;106:886–890
  30. Calderwood S, Blanchette V, Doyle J, et al.  Idiopathic thrombocytopenia and neutropenia in childhood. Am Pediatr Hematol Oncol. 1994;16:95–101
  31. Calpin C, Dick P, Poon A, et al.  Is bone marrow aspiration needed in acute childhood idiopathic thrombocytopenic purpura to rule out leukemia?. Arch Pediatr Adolesc Med. 1998;152:345–347
  32. Carcao MD, Zipursky A, Butchart S, et al.  Short-course oral prednisone therapy in children presenting with acute immune thrombocytopenic purpura. Acta Paediatr. 1998;87(suppl 424):71–74
  33. Centers for Disease Control and Prevention: Recommendations of the Advisory Committee on Immunization Practices (ACIP) . Use of vaccines and immune globulins in persons with altered immunocompetence. MMWR42:RR-04. 1993;
  34. Chen J-S, Wu J-M, Chen Y-J, et al.  Pulsed high-dose dexamethasone therapy in children with chronic idiopathic thrombocytopenic purpura. Pediatr Hematol Oncol. 1997;19:526–529
  35. Chessells J. Chronic idiopathic thrombocytopenic purpura: Primum non nocere. Arch Dis Child. 1989;64:1326–1328
  36. Crosby WH. Wet purpura, dry purpura. JAMA. 1975;232:744–745
  37. Dubansky AS, Oski FA. Controversies in the management of acute idiopathic purpura: A survey of specialists. Pediatrics. 1986;77:49–52
  38. Eden OB, Lilleyman JS. Guidelines for management of idiopathic thrombocytopenic purpura. Arch Dis Child. 1992;67:1056–1058
  39. Emilia G, Messora C, Longo G, et al.  Long-term salvage treatment by cyclosporin in refractory autoimmune haematologic disorders. Br J Haematol. 1996;93:341–344
  40. Facon T, Caulier MT, Fenaux P, et al.  Accessory spleen in recurrent chronic immune thrombocytopenic purpura. Am J Hematol. 1992;41:184–189
  41. Figueroa M, Gehlsen J, Hammond D, et al.  Combination chemotherapy in refractory immune thrombocytopenic purpura. N Engl J Med. 1993;328:1226–1229
  42. Fitzgerald PG, Langer JC, Cameron BH, et al.  Pediatric laparoscopic splenectomy using the lateral approach. Surg Endosc. 1996;10:859–861
  43. Gaston MH, Verter JI, Woods G, et al.  Prophylaxis with oral penicillin in children with sickle cell anemia. A randomized trial. N Engl J Med. 1986;314:1593–1599
  44. George JN, Woolf SH, Raskob GE, et al.  Idiopathic thrombocytopenic purpura: A practice guideline developed by explicit methods for the American Society of Hematology. Blood. 1996;88:3–40
  45. Gibson J, May J, Rickard KA, et al.  Management of splenectomy failures in chronic immune thrombocytopenic purpura: Role of accessory splenectomy. Aust NZ J Med. 1986;16:695–698
  46. Gigot J-F, de Ville de Goyet J, van Beers BE, et al.  Laparoscopic splenectomy in adults and children: Experience with 31 patients. Surgery. 1996;119:384–389
  47. Halperin DS, Doyle JJ. Is bone marrow examination justified in idiopathic thrombocytopenic purpura?. Am J Dis Child. 1988;142:508–511
  48. Hilgartner MW, Lanzkowsky P, Smith CH. The use of azathioprine in refractory idiopathic thrombocytopenic purpura in children. Acta Paediatr Scand. 1970;59:409–415
  49. Imbach P, Akatsuka J, Blanchette V, et al.  Immunothrombo-cytopenic purpura as a model for pathogenesis and treatment of autoimmunity. Eur J Pediatr. 1995;154(suppl 3):S60–S64
  50. Infectious Diseases and Immunization Committee, Canadian Paediatric Society . Prevention and therapy of bacterial infections for children with asplenia or hyposlpenia. Pediatr Child Health. 1999;4:417–421
  51. Jackson CW, Edwards CC. Evidence that stimulation of megakaryocytopoiesis by low dose vincristine results from an effect on platelets. Br J Haematol. 1977;36:97–105
  52. Karpatkin S. Autoimmune (idiopathic) thrombocytopenic purpura. Lancet. 1997;349:1531–1536
  53. Kelton JG, McDonald JWD, Barr RM, et al.  The reversible binding of vinblastine to platelets: Implications for therapy. Blood. 1981;57:431–436
  54. Korones DN. High-dose oral dexamethasone therapy in idiopathic thrombocytopenic purpura. J Pediatr. 1996;129:772; (editorial)
  55. Kühne T, Freedman J, Semple JW, et al.  Platelet and immune responses to oral cyclic dexamethasone therapy in childhood chronic immune thrombocytopenic purpura. J Pediatr. 1997;130:17–24
  56. Lammi AT, Lovric VA. Idiopathic thrombocytopenic purpura: An epidemiologic study. J Pediatr. 1973;83:31–36
  57. Law C, Marcaccio M, Tam P, et al.  High-dose intravenous immunoglobulin and the response to splenectomy in patients with idiopathic thrombocytopenic purpura. N Engl J Med. 1997;336:1494–1498
  58. Lilleyman JS. Intracranial haemorrhage in idiopathic thrombocytopenic purpura. Arch Dis Child. 1994;71:251–253
  59. Lusher JM, Zuelzer WW. Idiopathic thrombocytopenic purpura in childhood. J Pediatr. 1966;68:971–979
  60. McMillan R, Tani P, Millard P, et al.  Platelet-associated and plasma anti-glycoprotein autoantibodies in chronic ITP. Blood. 1987;70:1040–1045
  61. McMillan R. Therapy for adults with refractory chronic immune thrombocytopenic purpura. Ann Intern Med. 1997;126:307–314
  62. Medeiros D, Buchanan GR. Major hemorrhages in children with idiopathic thrombocytopenic purpura: Immediate response to therapy and long-term outcome. J Pediatr. 1998;133:334–339
  63. Moskowitz IPG, Gaynon PS, Shahidi NT, et al.  Low-dose cyclosporin A therapy in children with refractory immune thrombocytopenic purpura. J Pediatr Hematol Oncol. 1999;21:77–79
  64. Najean Y, Dufour V, Rain JD, et al.  The site of platelet destruction in thrombocytopenic purpura as a predictive index of the efficacy of splenectomy. Br J Haematol. 1991;79:271–276
  65. Nichol JL. The Mpl ligand and platelet homeostasis. Acta Paediatr. 1998;87(suppl 424):7–15
  66. Özsoylu S, Irken G, Karabent A. High-dose intravenous methylprednisolone for acute childhood idiopathic thrombo-cytopenic purpura. Eur J Haematol. 1989;42:431–435
  67. Özsoylu S, Sayli TR, Öztürk G. Oral megadose methylpred-nisolone versus intravenous immunoglobulin for acute childhood idiopathic thrombocytopenic purpura. Pediatr Hematol Oncol. 1993;10:317–321
  68. Pohlson EC, Wilkinson RW, Witzum KF, et al.  Heatdamaged red cell scan for intraoperative localization of the accessory spleen. J Pediatr Surg. 1994;29:604–608
  69. Quiquandon I, Fenaux P, Caulier MT, et al.  Re-evaluation of the role of azathioprine in the treatment of adult chronic idiopathic thrombocytopenic purpura: A report on 53 cases. Br J Haematol. 1990;74:223–228
  70. Ramos MEG, Newman AJ, Gross S. Chronic thrombocytopenia in childhood. J Pediatr. 1978;92:584–586
  71. Reid MM. Bone marrow examination before steroids in thrombocytopenic purpura or arthritis. Acta Paediatr. 1992;81:1052–1053
  72. Reid MM. Chronic idiopathic thrombocytopenic purpura: Incidence, treatment, and outcome. Arch Dis Child. 1995;72:125–128
  73. Reiner A, Gernsheimer T, Slichter SJ. Pulse cyclophosphamide therapy for refractory autoimmune thrombocytopenic purpura. Blood. 1995;85:351–358
  74. Robb LG, Tiedeman K. Idiopathic thrombocytopenic purpura: Predictors of chronic disease. Arch Dis Child. 1990;65:502–506
  75. Rosenthal N, Vogel P, Lee S, et al.  The role of accessoryspleens in post-splenectomy recurrent purpura hemorrhagica. Mt Sinai J Med NY. 1951;17:1008–1020
  76. Ruivard M, Caulier MT, Vantelon JM, et al.  The response to high-dose intravenous immunoglobulin or steroids is not predictive of outcome after splenectomy in adults with autoimmune thrombocytopenic purpura. Br J Haematol. 1999;105:1130–1132
  77. Saxon BR, Mody M, Blanchette VS, et al.  Reticulated platelet counts in the assessment of thrombocytopenic disorders. Acta Paediatr. 1998;87(suppl 424):65–70
  78. Scaradavou A, Bussel J. Evans syndrome. Results of a pilot study utilizing a multiagent treatment protocol. J Pediatr Hematol Oncol. 1995;17:290–295
  79. Scaradavou A, Woo B, Woloski BMR, et al.  Intravenous anti-D treatment of immune thrombocytopenic purpura: experience in 272 patients. Blood. 1997;89:2689–2700
  80. Schultz KR, Strahlendorf C, Warrier I, et al.  Cyclosporin A therapy of immune-mediated thrombocytopenia in children. Blood. 1995;85:1406–1408
  81. Schwartz RS. Treating chronic idiopathic thrombocytopenic purpura—a new application of an old treatment. N Engl J Med. 1994;330:1609–1610
  82. Simons SM, Main CA, Yaish HM, et al.  Idiopathic thrombocytopenic purpura in children. J Pediatr. 1975;87:16–22
  83. Suarez CR, Rademaker D, Hasson A, et al.  High-dose steroids in childhood acute idiopathic thrombocytopenic purpura. Am J Pediatr Hematol Oncol. 1986;8:111–115
  84. Tamary H, Kaplinsky C, Levy I, et al.  Chronic childhood idiopathic thrombocytopenic purpura: Long-term follow-up. Acta Pediatr. 1994;83:931–934
  85. Tarantino MD, Madden RM, Fennewald DL, et al.  Treatment of childhood acute immune thrombocytopenic purpura with anti-D immune globulin or pooled immune globulin. J Pediatr. 1999;134:21–26
  86. van Hoff J, Ritchey AK. Pulse methylprednisolone therapy for acute childhood idiopathic thrombocytopenic purpura. J Pediatr. 1988;113:563–566
  87. Verheyden CN, Beart RW, Clifton MD, et al.  Accessory splenectomy in management of recurrent idiopathic thrombocytopenic purpura. In: Mayo Clin Proc. 53:1978;p. 442–446
  88. Wang WC. Evans syndrome in childhood: Pathophysiology, clinical course, and treatment. Am J Pediatr Hematol Oncol. 1988;10:330–338
  89. Woerner SJ, Abildgaard CF, French BN. Intracranial hemorrhage in children with idiopathic thrombocytopenic purpura. Pediatrics. 1981;67:453–460
  90. Zuelzer WW, Lusher JM. Childhood idiopathic thrombocy-topenic purpura: To treat or not to treat?. Am J Dis Child. 1977;131:360–362

PII: S0037-1963(00)90108-2

Seminars in Hematology
Volume 37, Issue 3 , Pages 299-314 , July 2000

Article Tools