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https://www.readbyqxmd.com/read/28906353/immunomodulatory-treatments-for-persistent-and-chronic-immune-thrombocytopenic-purpura-a-prisma-compliant-systematic-review-and-meta-analysis-of-28-studies
#1
REVIEW
Emmanuelle Weber, Quitterie Reynaud, Romain Fort, Stéphane Durupt, Pascal Cathébras, Isabelle Durieu, Jean-Christophe Lega
BACKGROUND: Corticosteroid sparing is required in 15% to 40% of adults with persistent or chronic primary immune thrombocytopenic purpura (ITP). Herein, the efficacy of immunomodulatory drugs (dapsone, interferon alpha, danazol, and hydroxychloroquine as second-third-line therapies in ITP is investigated. METHODS: MEDLINE was searched for studies that included patients with persistent or chronic primary ITP and published before the end of December 2014. Two investigators independently extracted data regarding study design, patient characteristics, dosage schedule, time to response, and occurrence of adverse events...
September 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28726165/long-term-outcomes-of-laparoscopic-versus-open-splenectomy-for-immune-thrombocytopenia
#2
Kazuhiro Tada, Masayuki Ohta, Kunihiro Saga, Hiroomi Takayama, Teijiro Hirashita, Yuichi Endo, Hiroki Uchida, Yukio Iwashita, Masafumi Inomata
PURPOSE: Splenectomy is the standard therapy for medically refractory immune thrombocytopenia (ITP). Laparoscopic splenectomy (LS) has gained wide acceptance; however, the long-term outcomes of LS versus open splenectomy (OS) for patients with ITP remain unclear. METHODS: We analyzed, retrospectively, 32 patients who underwent splenectomy, as LS in 22 and OS in 10, for refractory ITP at our institute. Data were evaluated based on the American Society of Hematology 2011 evidence-based practice guidelines for ITP...
July 19, 2017: Surgery Today
https://www.readbyqxmd.com/read/28680366/fatal-pulmonary-embolism-following-splenectomy-in-a-patient-with-evan-s-syndrome-case-report-and-review-of-the-literature
#3
Varun Monga, Seth M Maliske, Usha Perepu
BACKGROUND: Evans syndrome (ES) is a rare disease characterized by simultaneous or sequential development of autoimmune hemolytic anemia (AIHA) and immune thrombocytopenia (ITP) with or without immune neutropenia. Splenectomy is one of the treatment options for disease refractory to medical therapy. Venous thromboembolism (VTE) following splenectomy for hematological diseases has an incidence of 10%. CASE PRESENTATION: Here we describe a case report of a young patient hospitalized with severe hemolytic anemia with Hgb 4...
2017: Thrombosis Journal
https://www.readbyqxmd.com/read/28416506/clinical-updates-in-adult-immune-thrombocytopenia
#4
REVIEW
Michele P Lambert, Terry B Gernsheimer
Immune thrombocytopenia (ITP) occurs in 2 to 4/100 000 adults and results in variable bleeding symptoms and thrombocytopenia. In the last decade, changes in our understanding of the pathophysiology of the disorder have led to the publication of new guidelines for the diagnosis and management of ITP and standards for terminology. Current evidence supports alternatives to splenectomy for second-line management of patients with persistently low platelet counts and bleeding. Long-term follow-up data suggest both efficacy and safety, in particular, for the thrombopoietin receptor agonists and the occurrence of late remissions...
May 25, 2017: Blood
https://www.readbyqxmd.com/read/28370285/identification-and-characterization-of-a-nationwide-danish-adult-common-variable-immunodeficiency-cohort
#5
L Westh, T H Mogensen, L S Dalgaard, J M Bernth Jensen, T Katzenstein, A-B E Hansen, O D Larsen, S Terpling, T L Nielsen, C S Larsen
In this study, we identified all adults living in Denmark diagnosed with common variable immunodeficiency (CVID) and characterized them according to clinical presentation and EUROclass classification. Using a retrospective, cross-sectional design, possible CVID patients were identified in the Danish National Patient Register and Centers in Denmark treating patients with primary immunodeficiencies. The CVID diagnosis was verified by review of medical records. One-hundred-seventy-nine adults with CVID were identified...
June 2017: Scandinavian Journal of Immunology
https://www.readbyqxmd.com/read/28370250/using-a-standardised-protocol-was-effective-in-reducing-hospitalisation-and-treatment-use-in-children-with-newly-diagnosed-immune-thrombocytopenia
#6
R Labrosse, M Vincent, U-P Nguyen, C Chartrand, L Di Liddo, Y Pastore
AIM: Childhood immune thrombocytopenia (ITP) has been associated with low bleeding rates and a high frequency of spontaneous remission. Although current guidelines suggest that most patients are just observed, children still receive platelet-enhancing therapies for fear of bleeding complications. We hypothesised that a standardised protocol with a step-down approach would reduce hospitalisation and treatment use. METHOD: A retrospective chart review was performed on patients diagnosed with acute ITP between January 2010 and December 2014, before (n = 54) and after (n = 37) the standardised protocol, which was introduced in January 2013...
October 2017: Acta Paediatrica
https://www.readbyqxmd.com/read/28295192/state-of-the-art-how-i-manage-immune-thrombocytopenia
#7
REVIEW
Nichola Cooper
The management of patients with immune thrombocytopenia (ITP) is rapidly evolving. Over the last 15 years, a number of novel treatments have improved practice, with many steroid-sparing agents and a reduction in the progression to splenectomy. Although this has improved clinical care, many therapeutic challenges remain. There is no diagnostic test, no biomarkers to direct treatment and few comparative studies to help management decisions. Development of up to date guidelines is difficult with little high-grade evidence...
April 2017: British Journal of Haematology
https://www.readbyqxmd.com/read/28241875/long-term-acceptability-durability-and-bio-efficacy-of-zerovector-%C3%A2-durable-lining-for-vector-control-in-papua-new-guinea
#8
Joseph J Kuadima, Lincoln Timinao, Laura Naidi, Anthony Tandrapah, Manuel W Hetzel, Cyrille Czeher, Justin Pulford
BACKGROUND: This study examined the acceptability, durability and bio-efficacy of pyrethroid-impregnated durable lining (DL) over a three-year period post-installation in residential homes across Papua New Guinea (PNG). METHODS: ZeroVector(®) ITPS had previously been installed in 40 homes across four study sites representing a cross section of malaria transmission risk and housing style. Structured questionnaires, DL visual inspections and group interviews (GIs) were completed with household heads at 12- and 36-months post-installation...
February 28, 2017: Malaria Journal
https://www.readbyqxmd.com/read/28071659/acg-clinical-guideline-treatment-of-helicobacter-pylori-infection
#9
William D Chey, Grigorios I Leontiadis, Colin W Howden, Steven F Moss
Helicobacter pylori (H. pylori) infection is a common worldwide infection that is an important cause of peptic ulcer disease and gastric cancer. H. pylori may also have a role in uninvestigated and functional dyspepsia, ulcer risk in patients taking low-dose aspirin or starting therapy with a non-steroidal anti-inflammatory medication, unexplained iron deficiency anemia, and idiopathic thrombocytopenic purpura. While choosing a treatment regimen for H. pylori, patients should be asked about previous antibiotic exposure and this information should be incorporated into the decision-making process...
February 2017: American Journal of Gastroenterology
https://www.readbyqxmd.com/read/27781392/increasing-observation-rates-in-low-risk-pediatric-immune-thrombocytopenia-using-a-standardized-clinical-assessment-and-management-plan-scamp-%C3%A2
#10
Michelle L Schoettler, Dionne Graham, Wen Tao, Margaret Stack, Elaine Shu, Lauren Kerr, Ellis J Neufeld, Rachael F Grace
An observational approach is recommended in newly diagnosed children with immune thrombocytopenia (ITP) at low risk of bleeding; however, there is no standard definition of risk. A standardized clinical assessment and management plan (SCAMP(®) ), a modifiable practice guideline, was implemented and revised (SCAMP-1 and SCAMP-2) and applied to 71 newly diagnosed patients with ITP. The Buchanan and Adix bleeding score guided treatment and was modified by stratifying by low- and high-risk grade 3 bleeding in SCAMP-2...
May 2017: Pediatric Blood & Cancer
https://www.readbyqxmd.com/read/27699328/diagnosis-and-management-of-immune-thrombocytopenia-in-childhood
#11
REVIEW
Thomas Kühne
Evidence-based medicine is growing in immune thrombocytopenia (ITP), but solid clinical data are still lacking in many areas. A majority of children has self-limited ITP, but chronic symptomatic ITP exists also in pediatrics. Management includes a watch-and-wait strategy for children with newly diagnosed ITP and no or mild bleeding, and immunoglobulins and corticosteroids, if more bleeding and mucous membrane involvement is present. Treatment endpoints differ in clinical research and in clinical practice. The requirement of platelet enhancing drugs needs to be better defined in guidelines...
January 31, 2017: Hämostaseologie
https://www.readbyqxmd.com/read/27583208/fatal-purpura-fulminans-and-waterhouse-friderichsen-syndrome-from-fulminant-streptococcus-pneumoniae-sepsis-in-an-asplenic-young-adult
#12
Andrew J Hale, Mary LaSalvia, James E Kirby, Allison Kimball, Rachel Baden
Asplenic patients are at increased risk for sepsis and fulminant infection. Sepsis in these patients is typically secondary to encapsulated bacteria, with Streptococcus pneumoniae being the most frequent pathogen. Rare complications of severe sepsis include purpura fulminans and bilateral adrenal hemorrhage (Waterhouse-Friderichsen syndrome). We present the case of a 36-year-old woman, healthy except for splenectomy years prior for idiopathic thrombocytopenic purpura treatment, who presented with fever. Upon presentation to our hospital, three hours after symptoms onset, she had purpura fulminans and shock...
2016: IDCases
https://www.readbyqxmd.com/read/27441004/advances-in-diagnosis-and-treatments-for-immune-thrombocytopenia
#13
REVIEW
Shosaku Nomura
Immune thrombocytopenia (ITP) is an acquired hemorrhagic condition characterized by the accelerated clearance of platelets caused by antiplatelet autoantibodies. A platelet count in peripheral blood <100 × 10(9)/L is the most important criterion for the diagnosis of ITP. However, the platelet count is not the sole diagnostic criterion, and the diagnosis of ITP is dependent on additional findings. ITP can be classified into three types, namely, acute, subchronic, and persistent, based on disease duration...
2016: Clinical Medicine Insights. Blood Disorders
https://www.readbyqxmd.com/read/27312164/management-of-chronic-immune-thrombocytopenia-in-children-and-adolescents-lessons-from-an-austrian-national-cross-sectional-study-of-81-patients
#14
J Sipurzynski, B Fahrner, R Kerbl, R Crazzolara, N Jones, G Ebetsberger, B Jauk, V Strenger, B Wohlmuther, W Schwinger, H Lackner, C Urban, W Holter, M Minkov, L Kager, M Benesch, M G Seidel
Chronic immune thrombocytopenia (cITP) is often associated with an underlying predisposition towards autoimmunity, recognition of which is relevant to guide treatment. International recommendations on diagnostic steps and therapeutic measures of cITP in childhood exist. However, due to the low prevalence (1-2/100,000) and a variation of availability of immunological and hematological tests and treatments across pediatric units, we postulated that these guidelines are not uniformly adhered to and that immune dysregulation syndromes remained undiscovered...
April 2016: Seminars in Hematology
https://www.readbyqxmd.com/read/27271117/the-differential-effects-of-norepinephrine-and-dopamine-on-cerebrospinal-fluid-pressure-and-spinal-cord-perfusion-pressure-after-acute-human-spinal-cord-injury
#15
COMPARATIVE STUDY
F Altaf, D E Griesdale, L Belanger, L Ritchie, J Markez, T Ailon, M C Boyd, S Paquette, C G Fisher, J Street, M F Dvorak, B K Kwon
STUDY DESIGN: Prospective vasopressor cross-over interventional studyObjectives:To examine how two vasopressors used in acute traumatic spinal cord injury (SCI) affect intrathecal cerebrospinal fluid pressure and the corresponding spinal cord perfusion pressure (SCPP). SETTING: Vancouver, British Columbia, Canada. METHODS: Acute SCI patients over the age of 17 with cervical or thoracic ASIA Impairment Scale (AIS). A, B or C injuries were enrolled in this study...
January 2017: Spinal Cord
https://www.readbyqxmd.com/read/27098812/real-life-management-of-primary-immune-thrombocytopenia-itp-in-adult-patients-and-adherence-to-practice-guidelines
#16
María Luisa Lozano, N Revilla, T J Gonzalez-Lopez, S Novelli, J R González-Porras, B Sánchez-Gonzalez, N Bermejo, S Pérez, F J Lucas, M T Álvarez, M J Arilla, M Perera, J do Nascimento, R M Campos, L F Casado, V Vicente
Very few data exist on the management of adult patients diagnosed with primary immune thrombocytopenia (ITP). The objectives of this study were to describe the diagnostic and treatment patterns for ITP and to compare the findings to recent ITP guidelines. We retrospectively analyzed the medical records of adult ITP patients diagnosed with primary ITP between January 2011 and June 2012 and examined whether management strategies were consistent or not with eight recent guideline-recommended practices. Overall, median age at the diagnosis of the disease (n = 101) was 58 years and median platelet count 12 × 10(9)/L with 75...
June 2016: Annals of Hematology
https://www.readbyqxmd.com/read/27015661/immune-thrombocytopenia-after-bee-venom-therapy-a-case-report
#17
Mohammad Adel Abdulsalam, Bader Esmael Ebrahim, Ahmad Jasem Abdulsalam
BACKGROUND: Immune thrombocytopenia (ITP) is a hematological disorder with an isolated decrease in number of circulating platelets. Bee venom therapy (BVT) is a form of alternative medicine. It is still being practiced in the Middle East and other parts of Asia. In BVT, acupuncture points are used to inject diluted bee venom into the body. The pharmacological basis behind BVT is not fully understood. However, it has been used to treat various medical conditions such as arthritis and low back pain...
March 25, 2016: BMC Complementary and Alternative Medicine
https://www.readbyqxmd.com/read/26941022/hospitalizations-in-pediatric-patients-with-immune-thrombocytopenia-in-the-united-states
#18
Michael D Tarantino, Mark Danese, Robert J Klaassen, Jennifer Duryea, Melissa Eisen, James Bussel
To examine utilization and outcomes in pediatric immune thrombocytopenia (ITP) hospitalizations, we used ICD-9 code 287.31 to identify hospitalizations in patients with ITP in the 2009 HCUP KID, an all-payer sample of pediatric hospitalizations from US community hospitals. Diagnosis and procedure codes were used to estimate rates of ITP-related procedures, comorbidity prevalence, costs, length of stay (LOS), and mortality. In 2009, there were an estimated 4499 hospitalizations in children aged 6 months-17 years with ITP; 43% in children aged 1-5 years; and 47% with emergency department encounters...
July 2016: Platelets
https://www.readbyqxmd.com/read/26929009/multicenter-cohort-study-comparing-u-s-management-of-inpatient-pediatric-immune-thrombocytopenia-to-current-treatment-guidelines
#19
MULTICENTER STUDY
Char M Witmer, Michele P Lambert, Sarah H O'Brien, Cindy Neunert
BACKGROUND: Recent pediatric immune thrombocytopenia (ITP) guidelines have significantly altered and are encouraging an observational approach for patients without significant bleeding regardless of their platelet count. PROCEDURE: This retrospective multicenter cohort study utilized the Pediatric Health Information Systems (PHIS) administrative database. Subjects were 6 months to 18 years of age, admitted to a PHIS hospital between January 1, 2008 and September 30, 2014, with a primary diagnosis code for ITP...
July 2016: Pediatric Blood & Cancer
https://www.readbyqxmd.com/read/26849975/-on-demand-romiplostim-therapy-in-immune-thrombocytopenia
#20
M Mitrovic, I Elezovic, N Suvajdzic-Vukovic
WHAT IS KNOWN AND OBJECTIVE: Although thrombopoietin receptor agonists are a second-line treatment for refractory immune thrombocytopenia (ITP), we lack guidelines recommending maintenance modality in patients who achieve complete remission (CR). CASE SUMMARY: We report a patient with refractory ITP who achieved CR on romiplostim. Obtaining romiplostim for 6 months of therapy, we decided to try extending this by modifying the standard treatment regimen. Romiplostim was successfully administered 'on-demand', only if the patient's platelet count dropped below 150 × 10(9) /L, over a period of 12 months...
June 2016: Journal of Clinical Pharmacy and Therapeutics
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