search for




 

Review Article
Diagnostic Approach of Childhood Immune Thrombocytopenia
Clin Pediatr Hematol Oncol 2018;25:10-6.
Published online April 30, 2018
© 2018 Korean Society of Pediatric Hematology-Oncology and Korean Society for Pediatric Neuro-Oncology

Ji Yoon Kim, M.D.

Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Korea
Correspondence to: Ji Yoon Kim
Department of Pediatrics, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea
Tel: +82-53-200-5704 Fax: +82-53-425-6683
E-mail: phojyk@knu.ac.kr
Received April 3, 2018; Revised April 9, 2018; Accepted April 11, 2018.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
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.
Keywords: Children, Diagnosis, Immune thrombocytopenia, Nonimmune thrombocyto-penia, Secondary ITP
References
  1. Jang JH, Kim JY, Mun YC, et al. Management of immune thrombocytopenia: Korean experts recommendation in 2017. Blood Res 2017;52:254-63.
    Pubmed KoreaMed CrossRef
  2. Cines DB, Blanchette VS. Immune thrombocytopenic purpura. N Engl J Med 2002;346:995-1008.
    Pubmed CrossRef
  3. Barsam SJ, Psaila B, Forestier M, et al. Platelet production and platelet destruction: assessing mechanisms of treatment effect in immune thrombocytopenia. Blood 2011;117:5723-32.
    Pubmed KoreaMed CrossRef
  4. Neunert C, Lim W, Crowther M, et al. The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia. Blood 2011;117:4190-207.
    Pubmed CrossRef
  5. Rodeghiero F, Stasi R, Gernsheimer T, et al. Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood 2009;113:2386-93.
    Pubmed CrossRef
  6. Choi EJ, Lee SM, Lee KS, et al. Childhood acute immune thrombocytopenic purpura in Korea--Multicenter Study of Korean Society of Pediatric Hematology/Oncology. Korean J Pediatr Hematol Oncol 2003;10:14-21.
  7. Ruggeri M, Fortuna S, Rodeghiero F. Heterogeneity of terminology and clinical definitions in adult idiopathic thrombocytopenic purpura: a critical appraisal from a systematic review of the literature. Haematologica 2008;93:98-103.
    Pubmed CrossRef
  8. Higashigawa M, Maeyama T, Yoshino A, et al. Incidence of childhood primary immune thrombocytopenic purpura. Pediatr Int 2015;57:1041-3.
    Pubmed CrossRef
  9. Kistangari G, McCrae KR. Immune thrombocytopenia. Hematol Oncol Clin North Am 2013;27:495-520.
    Pubmed KoreaMed CrossRef
  10. Broos K, Feys HB, De Meyer SF, Vanhoorelbeke K, Deckmyn H. Platelets at work in primary hemostasis. Blood Rev 2011;25:155-67.
    Pubmed CrossRef
  11. George JN. Platelets. Lancet 2000;355:1531-9.
    CrossRef
  12. Xu XR, Zhang D, Oswald BE, et al. Platelets are versatile cells: New discoveries in hemostasis, thrombosis, immune responses, tumor metastasis and beyond. Crit Rev Clin Lab Sci 2016;53:409-30.
    Pubmed CrossRef
  13. Rodeghiero F, Michel M, Gernsheimer T, et al. Standardization of bleeding assessment in immune thrombocytopenia: report from the International Working Group. Blood 2013;121: 2596-606.
    Pubmed CrossRef
  14. Israels SJ, Kahr WH, Blanchette VS, Luban NL, Rivard GE, Rand ML. Platelet disorders in children: a diagnostic approach. Pediatr Blood Cancer 2011;56:975-83.
    Pubmed CrossRef
  15. Smock KJ, Perkins SL. Thrombocytopenia: an update. Int J Lab Hematol 2014;36:269-78.
    Pubmed CrossRef
  16. British Committee for Standards in Haematology General Haematology Task Force. Guidelines for the investigation and management of idiopathic thrombocytopenic purpura in adults, children and in pregnancy. Br J Haematol 2003;120: 574-96.
    Pubmed CrossRef
  17. Consolini R, Costagliola G, Spatafora D. The centenary of immune thrombocytopenia-part 2: revising diagnostic and therapeutic approach. Front Pediatr 2017;5:179.
    Pubmed KoreaMed CrossRef
  18. Lowe EJ, Buchanan GR. Idiopathic thrombocytopenic purpura diagnosed during the second decade of life. J Pediatr 2002;141:253-8.
    Pubmed CrossRef
  19. Cooper N. A review of the management of childhood immune thrombocytopenia: how can we provide an evidence-based approach? Br J Haematol 2014;165:756-67.
    Pubmed CrossRef
  20. Cines DB, Bussel JB. How I treat idiopathic thrombocytopenic purpura (ITP). Blood 2005;106:2244-51.
    Pubmed CrossRef
  21. Labarque V, Van Geet C. Clinical practice: immune thrombocytopenia in paediatrics. Eur J Pediatr 2014;173:163-72.
    Pubmed CrossRef
  22. Neunert C, Noroozi N, Norman G, et al. Severe bleeding events in adults and children with primary immune thrombocytopenia: a systematic review. J Thromb Haemost 2015;13: 457-64.
    Pubmed KoreaMed CrossRef
  23. Teachey DT, Lambert MP. Diagnosis and management of autoimmune cytopenias in childhood. Pediatr Clin North Am 2013;60:1489-511.
    Pubmed KoreaMed CrossRef
  24. Del Vecchio GC, De Santis A, Accettura L, De Mattia D, Giordano P. Chronic immune thrombocytopenia in childhood. Blood Coagul Fibrinolysis 2014;25:297-9.
    Pubmed CrossRef
  25. Balduini CL, Noris P. Mean platelet volume for distinguishing between inherited thrombocytopenias and immune thrombocytopenia--response to Beyan. Br J Haematol 2013;163:413-4.
    Pubmed CrossRef
  26. Provan D, Stasi R, Newland AC, et al. International consensus report on the investigation and management of primary immune thrombocytopenia. Blood 2010;115:168-86.
    Pubmed CrossRef
  27. Hilário MO, Len CA, Roja SC, Terreri MT, Almeida G, Andrade LE. Frequency of antinuclear antibodies in healthy children and adolescents. Clin Pediatr (Phila) 2004;43:637-42.
    CrossRef
  28. 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.
    Pubmed
  29. Shin HY. Immune thrombocytopenic purpura (ITP). Korean J Pediatr 2006;49:830-2.
    CrossRef
  30. Blanchette V, Bolton-Maggs P. Childhood immune thrombocytopenic purpura: diagnosis and management. Hematol Oncol Clin North Am 2010;24:249-73.
    Pubmed CrossRef
  31. Yenicesu I, Yetgin S, Ozyürek E, Aslan D. Virus-associated immune thrombocytopenic purpura in childhood. Pediatr Hematol Oncol 2002;19:433-7.
    Pubmed CrossRef
  32. Smalisz-Skrzypczyk K, Romiszewski M, Matysiak M, Demkow U, Pawelec K. The influence of primary cytomegalovirus or Epstein-Barr virus infection on the course of idiopathic thrombocytopenic purpura. Adv Exp Med Biol 2016;878:83-8.
    Pubmed CrossRef
  33. Shah I. Immune thrombocytopenic purpura: a presentation of HIV infection. J Int Assoc Provid AIDS Care 2013;12:95-7.
    Pubmed CrossRef
  34. Pacifico L, Osborn JF, Tromba V, Romaggioli S, Bascetta S, Chiesa C. Helicobacter pylori infection and extragastric disorders in children: a critical update. World J Gastroenterol 2014;20:1379-401.
    Pubmed KoreaMed CrossRef
  35. Sakuraya M, Murakami H, Uchiumi H, et al. Steroid-refractory chronic idiopathic thrombocytopenic purpura associated with hepatitis C virus infection. Eur J Haematol 2002;68:49-53.
    Pubmed CrossRef
  36. Stasi R. Immune thrombocytopenia: pathophysiologic and clinical update. Semin Thromb Hemost 2012;38:454-62.
    Pubmed CrossRef
  37. Chong BH, Choi PY, Khachigian L, Perdomo J. Drug-induced immune thrombocytopenia. Hematol Oncol Clin North Am 2013;27:521-40.
    Pubmed CrossRef
  38. Reese JA, Nguyen LP, Buchanan GR, et al. Drug-induced thrombocytopenia in children. Pediatr Blood Cancer 2013;60:1975-81.
    Pubmed CrossRef
  39. Kam T, Alexander M. Drug-induced immune thrombocytopenia. J Pharm Pract 2014;27:430-9.
    Pubmed CrossRef
  40. Takemoto CM, Streiff MB. Heparin-induced thrombocytopenia screening and management in pediatric patients.Hematology Am Soc Hematol Educ Program 2011;2011:162-9.
  41. Ward MM, Pyun E, Studenski S. Mortality risks associated with specific clinical manifestations of systemic lupus erythematosus. Arch Intern Med 1996;156:1337-44.
    Pubmed CrossRef
  42. Altintas A, Ozel A, Okur N, et al. Prevalence and clinical significance of elevated antinuclear antibody test in children and adult patients with idiopathic thrombocytopenic purpura. J Thromb Thrombolysis 2007;24:163-8.
    Pubmed CrossRef
  43. Hepburn AL, Narat S, Mason JC. The management of peripheral blood cytopenias in systemic lupus erythematosus. Rheumatology (Oxford) 2010;49:2243-54.
    Pubmed CrossRef
  44. Cheung E, Liebman HA. Thyroid disease in patients with immune thrombocytopenia. Hematol Oncol Clin North Am 2009;23:1251-60.
    Pubmed CrossRef
  45. Cordiano I, Betterle C, Spadaccino CA, Soini B, Girolami A, Fabris F. Autoimmune thrombocytopenia (AITP) and thyroid autoimmune disease (TAD): overlapping syndromes? Clin Exp Immunol 1998;113:373-8.
    Pubmed KoreaMed CrossRef
  46. Li P, Huang P, Yang Y, Hao M, Peng H, Li F. Updated understanding of autoimmune lymphoproliferative syndrome (ALPS). Clin Rev Allergy Immunol 2016;50:55-63.
    Pubmed CrossRef
  47. Notarangelo LD. Primary immunodeficiencies (PIDs) presenting with cytopenias. Hematology Am Soc Hematol Educ Program 2009:139-43.
    Pubmed CrossRef
  48. Patuzzo G, Barbieri A, Tinazzi E, et al. Autoimmunity and infection in common variable immunodeficiency (CVID). Autoimmun Rev 2016;15:877-82.
    Pubmed CrossRef
  49. Balduini CL, Savoia A, Seri M. Inherited thrombocytopenias frequently diagnosed in adults. J Thromb Haemost 2013;11: 1006-19.
    Pubmed CrossRef
  50. Drachman JG. Inherited thrombocytopenia: when a low platelet count does not mean ITP. Blood 2004;103:390-8.
    Pubmed CrossRef
  51. Pecci A. Diagnosis and treatment of inherited thrombocytopenias. Clin Genet 2016;89:141-53.
    Pubmed CrossRef
  52. Bader-Meunier B, Proulle V, Trichet C, et al. Misdiagnosis of chronic thrombocytopenia in childhood. J Pediatr Hematol Oncol 2003;25:548-52.
    Pubmed CrossRef
  53. Buchbinder D, Nugent DJ, Fillipovich AH. Wiskott-Aldrich syndrome: diagnosis, current management, and emerging treatments. Appl Clin Genet 2014;7:55-66.
    Pubmed KoreaMed CrossRef
  54. Thomas AS, Mehta AB, Hughes DA. Diagnosing Gaucher disease: an on-going need for increased awareness amongst haematologists. Blood Cells Mol Dis 2013;50:212-7.
    Pubmed CrossRef
  55. Wasserstein MP, Desnick RJ, Schuchman EH, et al. The natural history of type B Niemann-Pick disease: results from a 10-year longitudinal study. Pediatrics 2004;114:e672-7.
    Pubmed CrossRef
  56. Savoia A, Pastore A, De Rocco D, et al. Clinical and genetic aspects of Bernard-Soulier syndrome: searching for genotype/phenotype correlations. Haematologica 2011;96:417-23.
    Pubmed KoreaMed CrossRef
  57. Kim JY, Lee KH, Lee SC, Lee JY. Monosomy 22 mosaicism associated thrombocytopenia presenting as behcet's disease. Clin Pediatr Hematol Oncol 2012;19:40-3.
  58. Lassiter HA, Bibb KW, Bertolone SJ, Patel CC, Stroncek DF. Neonatal immune neutropenia following the administration of intravenous immune globulin. Am J Pediatr Hematol Oncol 1993;15:120-3.
    Pubmed CrossRef
  59. Curtis BR. Recent progress in understanding the pathogenesis of fetal and neonatal alloimmune thrombocytopenia. Br J Haematol 2015;171:671-82.
    Pubmed CrossRef
  60. Rinaldi M, Perricone C, Ortega-Hernandez OD, Perricone R, Shoenfeld Y. Immune thrombocytopaenic purpura: an autoimmune cross-link between infections and vaccines. Lupus 2014;23:554-67.
    Pubmed CrossRef
  61. Elalfy MS, Nugent D. Viruses, anti-viral therapy, and viral vaccines in children with immune thrombocytopenia. Semin Hematol 2016;53 Suppl 1:S70-2.
    Pubmed CrossRef


October 2018, 25 (2)
Full Text PDF
Citation
Send to a friend
Twitter
Facebook

Cited By Articles
  • CrossRef (0)

Author ORCID Information
  • Ji Yoon Kim