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Abstract
BACKGROUND Measles, mumps, rubella, and varicella (chickenpox) are serious diseases that can lead to serious complications, disability, and death. However, public debate over the safety of the trivalent MMR vaccine and the resultant drop in vaccination coverage in several countries persists, despite its almost universal use and accepted effectiveness. This is an update of a review published in 2005 and updated in 2012. OBJECTIVES To assess the effectiveness, safety, and long- and short-term adverse effects associated with the trivalent vaccine, containing measles, rubella, mumps strains (MMR), or concurrent administration of MMR vaccine and varicella vaccine (MMR+V), or tetravalent vaccine containing measles, rubella, mumps, and varicella strains (MMRV), given to children aged up to 15 years. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2019, Issue 5), which includes the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE (1966 to 2 May 2019), Embase (1974 to 2 May 2019), the WHO International Clinical Trials Registry Platform (2 May 2019), and ClinicalTrials.gov (2 May 2019). SELECTION CRITERIA We included randomised controlled trials (RCTs), controlled clinical trials (CCTs), prospective and retrospective cohort studies (PCS/RCS), case-control studies (CCS), interrupted time-series (ITS) studies, case cross-over (CCO) studies, case-only ecological method (COEM) studies, self-controlled case series (SCCS) studies, person-time cohort (PTC) studies, and case-coverage design/screening methods (CCD/SM) studies, assessing any combined MMR or MMRV / MMR+V vaccine given in any dose, preparation or time schedule compared with no intervention or placebo, on healthy children up to 15 years of age. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the methodological quality of the included studies. We grouped studies for quantitative analysis according to study design, vaccine type (MMR, MMRV, MMR+V), virus strain, and study settings. Outcomes of interest were cases of measles, mumps, rubella, and varicella, and harms. Certainty of evidence of was rated using GRADE. MAIN RESULTS We included 138 studies (23,480,668 participants). Fifty-one studies (10,248,159 children) assessed vaccine effectiveness and 87 studies (13,232,509 children) assessed the association between vaccines and a variety of harms. We included 74 new studies to this 2019 version of the review. Effectiveness Vaccine effectiveness in preventing measles was 95% after one dose (relative risk (RR) 0.05, 95% CI 0.02 to 0.13; 7 cohort studies; 12,039 children; moderate certainty evidence) and 96% after two doses (RR 0.04, 95% CI 0.01 to 0.28; 5 cohort studies; 21,604 children; moderate certainty evidence). The effectiveness in preventing cases among household contacts or preventing transmission to others the children were in contact with after one dose was 81% (RR 0.19, 95% CI 0.04 to 0.89; 3 cohort studies; 151 children; low certainty evidence), after two doses 85% (RR 0.15, 95% CI 0.03 to 0.75; 3 cohort studies; 378 children; low certainty evidence), and after three doses was 96% (RR 0.04, 95% CI 0.01 to 0.23; 2 cohort studies; 151 children; low certainty evidence). The effectiveness (at least one dose) in preventing measles after exposure (post-exposure prophylaxis) was 74% (RR 0.26, 95% CI 0.14 to 0.50; 2 cohort studies; 283 children; low certainty evidence). The effectiveness of Jeryl Lynn containing MMR vaccine in preventing mumps was 72% after one dose (RR 0.24, 95% CI 0.08 to 0.76; 6 cohort studies; 9915 children; moderate certainty evidence), 86% after two doses (RR 0.12, 95% CI 0.04 to 0.35; 5 cohort studies; 7792 children; moderate certainty evidence). Effectiveness in preventing cases among household contacts was 74% (RR 0.26, 95% CI 0.13 to 0.49; 3 cohort studies; 1036 children; moderate certainty evidence). Vaccine effectiveness against rubella is 89% (RR 0.11, 95% CI 0.03 to 0.42; 1 cohort study; 1621 children; moderate certainty evidence). Vaccine effectiveness against varicella (any severity) after two doses in children aged 11 to 22 months is 95% in a 10 years follow-up (rate ratio (rr) 0.05, 95% CI 0.03 to 0.08; 1 RCT; 2279 children; high certainty evidence). Safety There is evidence supporting an association between aseptic meningitis and MMR vaccines containing Urabe and Leningrad-Zagreb mumps strains, but no evidence supporting this association for MMR vaccines containing Jeryl Lynn mumps strains (rr 1.30, 95% CI 0.66 to 2.56; low certainty evidence). The analyses provide evidence supporting an association between MMR/MMR+V/MMRV vaccines (Jeryl Lynn strain) and febrile seizures. Febrile seizures normally occur in 2% to 4% of healthy children at least once before the age of 5. The attributable risk febrile seizures vaccine-induced is estimated to be from 1 per 1700 to 1 per 1150 administered doses. The analyses provide evidence supporting an association between MMR vaccination and idiopathic thrombocytopaenic purpura (ITP). However, the risk of ITP after vaccination is smaller than after natural infection with these viruses. Natural infection of ITP occur in 5 cases per 100,000 (1 case per 20,000) per year. The attributable risk is estimated about 1 case of ITP per 40,000 administered MMR doses. There is no evidence of an association between MMR immunisation and encephalitis or encephalopathy (rate ratio 0.90, 95% CI 0.50 to 1.61; 2 observational studies; 1,071,088 children; low certainty evidence), and autistic spectrum disorders (rate ratio 0.93, 95% CI 0.85 to 1.01; 2 observational studies; 1,194,764 children; moderate certainty). There is insufficient evidence to determine the association between MMR immunisation and inflammatory bowel disease (odds ratio 1.42, 95% CI 0.93 to 2.16; 3 observational studies; 409 cases and 1416 controls; moderate certainty evidence). Additionally, there is no evidence supporting an association between MMR immunisation and cognitive delay, type 1 diabetes, asthma, dermatitis/eczema, hay fever, leukaemia, multiple sclerosis, gait disturbance, and bacterial or viral infections. AUTHORS' CONCLUSIONS Existing evidence on the safety and effectiveness of MMR/MMRV vaccines support their use for mass immunisation. Campaigns aimed at global eradication should assess epidemiological and socioeconomic situations of the countries as well as the capacity to achieve high vaccination coverage. More evidence is needed to assess whether the protective effect of MMR/MMRV could wane with time since immunisation.
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Affiliation(s)
- Carlo Di Pietrantonj
- Azienda Sanitaria Locale ASL AL, Servizio Regionale di Riferimento per l'Epidemiologia, SSEpi-SeREMI, Via Venezia 6, Alessandria, Italy, 15121
| | - Alessandro Rivetti
- ASL CN2 Alba Bra, Dipartimento di Prevenzione - S.Pre.S.A.L, Via Vida 10, Alba, Piemonte, Italy, 12051
| | - Pasquale Marchione
- Italian Medicine Agency - AIFA, Signal Management Unit, Post-Marketing Surveillance Department, Via del Tritone 181, Rome, Italy, 00187
| | | | - Vittorio Demicheli
- Azienda Sanitaria Locale ASL AL, Servizio Regionale di Riferimento per l'Epidemiologia, SSEpi-SeREMI, Via Venezia 6, Alessandria, Italy, 15121
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Tanous O, Dujovny T, Hertzel G, Koren A, Levin C. Immune Thrombocytopenia Secondary to Hodgkin's Lymphoma in Children. Isr Med Assoc J 2020; 22:224-226. [PMID: 32286024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Immune thrombocytopenia (ITP) is an autoimmune disorder of variable origin that results in bleeding and decreased platelet count. Autoimmune abnormalities have been described in patients with malignancies including non-Hodgkin's lymphoma but are rarely described in patients with Hodgkin's lymphoma. OBJECTIVES To describe an unusual presentation of Hodgkin's lymphoma in an unusual age and alarm pediatricians of the challenging diagnosis. METHODS We present two cases that highlight an unusual clinical presentation of childhood Hodgkin's lymphoma occurring at an atypical age. RESULTS Over a 4-year period, two children aged 5 and 6 years were admitted for suspected ITP, both had cervical lymphadenopathy. Bone marrow examination showed no evidence of tumor or fibrosis. Biopsy of the lymph node was possible only after administration of intravenous immunoglobulins and normalization of the platelet count. Platelet counts increased after initiation of chemotherapy. CONCLUSIONS The identification of the clinical presentation of ITP as a possible presentation of Hodgkin's lymphoma is important to facilitate timely diagnosis and management.
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Affiliation(s)
- Osama Tanous
- Department of Pediatrics B, Emek Medical Center, Afula, Israel
- Rappaport Faculty of Medicine, Technion-Institute of Technology, Haifa, Israel
| | - Tal Dujovny
- Department of Pediatrics B, Emek Medical Center, Afula, Israel
- Rappaport Faculty of Medicine, Technion-Institute of Technology, Haifa, Israel
| | - Gabriel Hertzel
- Department of Pediatrics B, Emek Medical Center, Afula, Israel
| | - Ariel Koren
- Department of Pediatrics B, Emek Medical Center, Afula, Israel
- Rappaport Faculty of Medicine, Technion-Institute of Technology, Haifa, Israel
| | - Carina Levin
- Department of Pediatrics B, Emek Medical Center, Afula, Israel
- Rappaport Faculty of Medicine, Technion-Institute of Technology, Haifa, Israel
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Ichikawa T, Shimojima Y, Otuki T, Ueno KI, Kishida D, Sekijima Y. Acquired Amegakaryocytic Thrombocytopenia in Adult-onset Still's Disease: Successful Combination Therapy with Tocilizumab and Cyclosporine. Intern Med 2019; 58:3473-3478. [PMID: 31391399 PMCID: PMC6928498 DOI: 10.2169/internalmedicine.2929-19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Adult-onset Still's disease (AOSD) sometimes demonstrates hematologic disorder, whereas acquired amegakaryocytic thrombocytopenia (AAT) involvement is extremely rare. We herein report a 67-year-old woman with relapse of AOSD who concomitantly developed AAT. Thrombocytopenia along with high disease activity of AOSD was resistant to high-dose prednisolone, even in combination with methotrexate and tacrolimus. However, alternative treatment with cyclosporine after administering tocilizumab resulted in the improvement of thrombocytopenia, ultimately demonstrating that combination therapy based on suppressing the intractable disease activity of AOSD and subsequently adding a reliable immunosuppressant was required to achieve remission.
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Affiliation(s)
- Takanori Ichikawa
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Japan
| | - Yasuhiro Shimojima
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Japan
| | - Toshiaki Otuki
- Department of Laboratory Medicine, Shinshu University Hospital, Japan
| | - Ken-Ichi Ueno
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Japan
| | - Dai Kishida
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Japan
| | - Yoshiki Sekijima
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Japan
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Arcudi S, Ferrari B, Pontiggia S, Tufano A, Artoni A, Mancini I, Peyvandi F. Prevention of relapse in patients with acquired thrombotic thrombocytopenic purpura undergoing elective surgery: a case series. J Thromb Haemost 2019; 17:492-498. [PMID: 30629316 DOI: 10.1111/jth.14381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Indexed: 11/29/2022]
Abstract
Essentials Thrombotic thrombocytopenic purpura (TTP) is a life-threatening disease. Surgery is a possible trigger of acute TTP episodes and no guidelines are available. Six patients with severe ADAMTS-13 deficiency during remission underwent elective surgery. Patients were prophylactically treated to restore ADAMTS-13 activity and no relapses occurred. SUMMARY: Background Severe ADAMTS-13 deficiency has been recognized as the main risk factor for recurrence of thrombotic thrombocytopenic purpura (TTP). Several conditions, including surgery, may influence the levels of ultra-large von Willebrand factor and ADAMTS-13, acting as a trigger for an acute TTP event. Objectives To report our experience of management of six patients with acquired TTP who underwent elective surgery after prophylactic treatment to restore ADAMTS-13 activity levels. Patients Six patients followed for acquired TTP with severe ADAMTS-13 deficiency during remission were candidates for seven elective surgeries (inguinal hernioplasty, cholecystectomy, laparoscopic hysterectomy, oophorectomy, parotidectomy and two total hip arthroplasties). Results Four patients were treated with prophylactic plasma exchange (PEX) therapy immediately before surgery. One patient was treated with PEX therapy before her first surgery and with preemptive rituximab once her second surgery was scheduled. Because rituximab increased ADAMTS-13 levels only partially, she required one PEX procedure the day before her second surgery. One patient was treated with azathioprine after rituximab failure, obtaining a progressive increase of ADAMTS-13 activity to more than 40%. This level allowed her to undergo total hip arthroplasty without additional treatment. All surgeries were successful and no complications or relapses occurred. Conclusions Six patients with acquired TTP underwent seven successful surgical procedures using prophylaxis to restore ADAMTS-13 activity. Further observational studies or randomized clinical trials are needed to confirm whether prophylactic PEX could be the key factor in preventing relapse.
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Affiliation(s)
- Sara Arcudi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Barbara Ferrari
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
| | - Silvia Pontiggia
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
| | - Antonella Tufano
- Department of Clinical Medicine and Surgery, AOU Federico II, Naples, Italy
| | - A Artoni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
| | - Illaria Mancini
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Flora Peyvandi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
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Lukšić B, Karabuva S, Markić J, Polić B, Kovačević T, Meštrović J, Križaj I. Thrombocytopenic purpura following envenomation by the nose-horned viper (Vipera ammodytes ammodytes): Two case reports. Medicine (Baltimore) 2018; 97:e13737. [PMID: 30593149 PMCID: PMC6314653 DOI: 10.1097/md.0000000000013737] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Two clinical cases are reported of envenomation by the nose-horned viper (Vipera ammodytes ammodytes) venom of a 9-year-old boy and of an 84-year-old woman. PATIENT CONCERNS Both patients had been bitten on their extremities by such a snake in August near Split, a town in southern Croatia. DIAGNOSES Clinical manifestation of envenomation was severe in the case of the boy, being characterized by a severe coagulopathy. This was only just apparent in the case of the elderly woman, who suffered extensive local edema and hematoma at the site of the bite, together with a neurotoxic effect-bilateral ptosis. This was the first occasion of thrombocytopenic purpura being observed in patients envenomed by nose-horned viper venom. This unexpected clinical finding was characterized by an unusually profound thrombocytopenia of 5 and 10 × 10/L platelets of the respective patients on their admission to the hospital, together with purpura, observed on the face and thorax of both individuals. In the most serious cases, such pathology can be life threatening if not promptly recognized and treated. INTERVENTIONS The patients recovered quickly on receiving the specific antivenom along with all the usual supportive treatments. OUTCOMES No serious sequels were noticed at the moment of discharge. LESSONS Our finding constitutes an important message to clinicians to consider the possibility of such complications in the case of nose-horned viper envenomation.
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Affiliation(s)
- Boris Lukšić
- Clinical Department of Infectious Diseases, University Hospital of Split
- University of Split, School of Medicine
| | - Svjetlana Karabuva
- Clinical Department of Infectious Diseases, University Hospital of Split
| | - Joško Markić
- University of Split, School of Medicine
- Department of Pediatrics, University Hospital of Split, Split
| | - Branka Polić
- Department of Pediatrics, University Hospital of Split, Split
| | - Tanja Kovačević
- Department of Pediatrics, University Hospital of Split, Split
| | - Julije Meštrović
- University of Split, School of Medicine
- Department of Pediatrics, University Hospital of Split, Split
| | - Igor Križaj
- Department of Molecular and Biomedical Sciences, Jožef Stefan Institute, Ljubljana, Slovenia
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Davies SM, Dunger DB. Systemic Lupus Erythematosus in Child with Autoimmune Thrombocytopenic Purpura and Circulating Lupus Anticoagulant. J R Soc Med 2018; 80:186. [PMID: 3106634 PMCID: PMC1290730 DOI: 10.1177/014107688708000320] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Levy I, Laor R, Jiries N, Bejar J, Polliack A, Tadmor T. Amegakaryocytic Thrombocytopenia and Subsequent Aplastic Anemia Associated with Apparent Epstein-Barr Virus Infection. Acta Haematol 2018; 139:7-11. [PMID: 29301129 DOI: 10.1159/000484595] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 10/24/2017] [Indexed: 01/19/2023]
Abstract
Acquired amegakaryocytic thrombocytopenia (AAT), a rare entity characterized by severe thrombocytopenia and the absence of megakaryocytes in the bone marrow, may mimic or precede the diagnosis of aplastic anemia (AA). Here, we describe a patient who presented with apparent Epstein-Barr virus (EBV)-associated immune thrombocytopenia resistant to several lines of therapies, which was in fact a form of AAT with some features of AA. He eventually responded to therapy with eltrombopag, cyclosporine A (CSA), and antithymocyte globulin (ATG) and recovered completely. EBV infection is known to cause a variety of benign and malignant hematologic disorders, including bone marrow failure. However, to the best of our knowledge, this is the first case report of EBV-associated AAT. Treatment options for AAT are still not well defined, and even response to eltrombopag together with CSA and ATG does not always imply successful therapy. The natural history of EBV infection may well be sufficient to explain unexpected eventual recovery.
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Affiliation(s)
- Ilana Levy
- Internal Medicine B Department, Bnai Zion Medical Center, Haifa, Israel
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Watanabe A, Fukunari H, Kawai Y, Aoki M, Saito S, Umebayashi Y, Shitara K, Hayashi T, Watanabe G, Ajioka H. [A Patient with Basaloid Carcinoma of the Esophagus Removed Surgically after Pre-Operative Chemotherapy Who Developed TTP during Post-Operative Chemotherapy]. Gan To Kagaku Ryoho 2017; 44:1110-1113. [PMID: 29394550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A 63-year-old man presented with the chief complaint of an unpleasant feeling in the chest after a meal.Esophagogastroduodenoscopy revealed interminglement of ulcer infiltration type lesions and protruding lesions in the lower esophagus.A large type 1 protruding lesion was located mainly in the esophagogastric junction(EGJ)and it progressed towards the stomach.A hypertrophic and protruding lesion on the lower esophageal wall and a 6 cm tumor in the major axis of the fornix were observed on thoracic and abdominal CT, and an endocrine cell carcinoma or basaloid carcinoma were suggested after biopsy.Finally, we diagnosed a basaloid carcinoma after immunohistochemistry analysis.We administered 4 courses of TS-1 plus CDDP as pre-operative chemotherapy.Because of a significant reduction in tumor size, approximately 5 months after first presentation, we performed esophageal resection by right thoracotomy and laparotomy, and reconstructive surgery for the thoracic gastric duct.The pathological diagnosis was basaloid carcinoma with multiple foci of squamous cell carcinoma.After surgery, we continued chemotherapy with TS-1 plus CDDP, which was previously effective, but a liver metastasis appeared 8 months later.We discontinued chemotherapy because of a prominent decline in platelets.Because of the clinical symptoms, we diagnosed secondary thrombotic thrombocytopenic purpura accompanied by a malignant tumor.We implemented plasma exchange and steroid pulse therapy, but this patient experienced no therapeutic effect and died.
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Affiliation(s)
- Akemi Watanabe
- Dept. of Surgery, Niigata Prefectural Tokamachi Hospital
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Temple R, Bull K. Petechiae in a Newborn. Am Fam Physician 2015; 92:1017-1018. [PMID: 26760417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
MESH Headings
- Adult
- Antigens, Human Platelet/blood
- Diagnosis, Differential
- Disease Management
- Female
- Glucocorticoids/therapeutic use
- Humans
- Immunoglobulins, Intravenous/therapeutic use
- Infant, Newborn
- Infections/diagnosis
- Kasabach-Merritt Syndrome/diagnosis
- Monitoring, Immunologic
- Platelet Transfusion/methods
- Pregnancy
- Pregnancy Complications/diagnosis
- Pregnancy Complications/immunology
- Purpura/diagnosis
- Purpura/etiology
- Purpura/immunology
- Purpura, Thrombocytopenic/diagnosis
- Purpura, Thrombocytopenic/etiology
- Purpura, Thrombocytopenic/immunology
- Purpura, Thrombocytopenic/physiopathology
- Rh Isoimmunization/diagnosis
- Thrombocytopenia, Neonatal Alloimmune/diagnosis
- Thrombocytopenia, Neonatal Alloimmune/etiology
- Thrombocytopenia, Neonatal Alloimmune/immunology
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Affiliation(s)
| | - Kenneth Bull
- Naval Hospital Camp Lejeune, Jacksonville, NC, USA
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Affiliation(s)
- C Williams
- Mount Sinai Medical Center, New York, N.Y
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Abstract
Drug-induced immune thrombocytopenia (DIIT) is a relatively uncommon adverse reaction caused by drug-dependent antibodies (DDAbs) that react with platelet membrane glycoproteins only when the implicated drug is present. Although more than 100 drugs have been associated with causing DIIT, recent reviews of available data show that carbamazepine, eptifibatide, ibuprofen, quinidine, quinine, oxaliplatin, rifampin, sulfamethoxazole, trimethoprim, and vancomycin are probably the most frequently implicated. Patients with DIIT typically present with petechiae, bruising, and epistaxis caused by an acute, severe drop in platelet count (often to <20,000 platelets/pL). Diagnosis of DIIT is complicated by its similarity to other non-drug-induced immune thrombocytopenias, including autoimmune thrombocytopenia, posttransfusion purpura, and platelet transfusion refractoriness, and must be differentiated by temporal association of exposure to a candidate drug with an acute, severe drop in platelet count. Treatment consists of immediate withdrawal of the implicated drug. Criteria for strong evidence of DIIT include (1) exposure to candidate drug-preceded thrombocytopenia; (2) sustained normal platelet levels after discontinuing candidate drug; (3) candidate drug was only drug used before onset of thrombocytopenia or other drugs were continued or reintroduced after resolution of thrombocytopenia, and other causes for thrombocytopenia were excluded; and (4) reexposure to the candidate drug resulted in recurrent thrombocytopenia. Flow cytometry testing for DDAbs can be useful in confirmation of a clinical diagnosis, and monoclonal antibody enzyme-linked immunosorbent assay testing can be used to determine the platelet glycoprotein target(s), usually GPIIb/IIIa or GPIb/IX/V, but testing is not widely available. Several pathogenic mechanisms for DIIT have been proposed, including hapten, autoantibody, neoepitope, drug-specific, and quinine-type drug mechanisms. A recent proposal suggests weakly reactive platelet autoantibodies that develop greatly increased affinity for platelet glycoprotein epitopes through bridging interactions facilitated by the drug is a possible mechanism for the formation and reactivity of quinine- type drug antibodies.
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Affiliation(s)
- Brian R Curtis
- PhD, D(ABMLI), MT(ASCP)SBB, Director, Platelet and Neutrophil Immunology Lab, Blood Research Institute, BloodCenter of Wisconsin, PO Box 2178, Milwaukee, WI 53201-2178
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Abstract
We present a middle-aged man with history of lung adenocarcinoma, who was admitted with massive haemoptysis secondary to severe thrombocytopenia. Two weeks prior he was started on enoxaparin for a newly diagnosed pulmonary embolus and at that time required blood transfusions for anaemia. Our initial diagnosis was heparin-induced thrombocytopenia. His platelet count, however, did not improve despite receiving argatroban and platelet transfusions. Hence, we suspected post-transfusion purpura (PTP) and started him on intravenous immunoglobulin which brought his platelet count to normal levels. The serotonin-release assay was negative and platelet-antibody test was positive confirming PTP as our diagnosis. The patient eventually was transferred to hospice care because of the advanced stage lung cancer and died of respiratory failure.
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Affiliation(s)
- Parikshit Padhi
- Department of Internal Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA.
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Hoque MM, Rahman M, Rahman SM, Habibullah MM, Faruki MA, Rahman KH, Mamun AA, Hossain MA. Post-transfusion increment of platelet count in thrombocytopenic patients treated with platelet concentrates. Mymensingh Med J 2013; 22:64-68. [PMID: 23416811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The Platelet (PLT) Transfusion Therapy plays an important role in the support of surgical, haematological, oncological and transplant patients. The present study was assigned to find out the post transfusion increment of platelet count among the thrombocytopenic patients in Bangladeshi population. This descriptive study was conducted at the Departments of Haematology and Transfusion Medicine, BSMMU, Dhaka. Total 42 thrmbocytopenic patients were randomly assigned to receive a transfusion when their platelet counts below 10000 per cubic millimeter or with active bleeding. Pre transfusion and post transfusion platelet count were measured in all patients. Out of 42 patients, 26(61.90%) were male and 16(38.10%) were female. Leukemia was the most common cause of thrombocytopenia (47.62%). Most of the patients (71.34%) required transfusion of multiple units of platelet and 12(28.57%) patients required double units. Before transfusion of platelet concentrate <30×10⁸/L, 30-80×10⁸/L and >80×10⁸/L platelet count were found in 30(71.43%), 08(19.05%) and 04(09.52%) patients respectively. After transfusion of platelet concentrate <50×10⁸/L, 50-100×10⁸/L and >100×10⁸/L platelet count were found in 30(71.43%), 08(19.05%) and 04(09.52%) patients respectively. In all patients post transfusion platelet count increases but 2 or multiple units of transfusion were needed.
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Affiliation(s)
- M M Hoque
- Department of Transfusion Medicine, Dhaka Medical College, Dhaka, Bangladesh. dr_tapan2010@ yahoo.com
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Romiplostim: leukaemia after myelodysplastic syndromes. Prescrire Int 2012; 21:129. [PMID: 22844683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Abstract
BACKGROUND Mumps, measles and rubella (MMR) are serious diseases that can lead to potentially fatal illness, disability and death. However, public debate over the safety of the trivalent MMR vaccine and the resultant drop in vaccination coverage in several countries persists, despite its almost universal use and accepted effectiveness. OBJECTIVES To assess the effectiveness and adverse effects associated with the MMR vaccine in children up to 15 years of age. SEARCH METHODS For this update we searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 2), which includes the Cochrane Acute Respiratory Infections Group's Specialised Register, PubMed (July 2004 to May week 2, 2011) and Embase.com (July 2004 to May 2011). SELECTION CRITERIA We used comparative prospective or retrospective trials assessing the effects of the MMR vaccine compared to placebo, do nothing or a combination of measles, mumps and rubella antigens on healthy individuals up to 15 years of age. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed methodological quality of the included studies. One review author arbitrated in case of disagreement. MAIN RESULTS We included five randomised controlled trials (RCTs), one controlled clinical trial (CCT), 27 cohort studies, 17 case-control studies, five time-series trials, one case cross-over trial, two ecological studies, six self controlled case series studies involving in all about 14,700,000 children and assessing effectiveness and safety of MMR vaccine. Based on the available evidence, one MMR vaccine dose is at least 95% effective in preventing clinical measles and 92% effective in preventing secondary cases among household contacts.Effectiveness of at least one dose of MMR in preventing clinical mumps in children is estimated to be between 69% and 81% for the vaccine prepared with Jeryl Lynn mumps strain and between 70% and 75% for the vaccine containing the Urabe strain. Vaccination with MMR containing the Urabe strain has demonstrated to be 73% effective in preventing secondary mumps cases. Effectiveness of Jeryl Lynn containing MMR in preventing laboratory-confirmed mumps cases in children and adolescents was estimated to be between 64% to 66% for one dose and 83% to 88% for two vaccine doses. We did not identify any studies assessing the effectiveness of MMR in preventing rubella.The highest risk of association with aseptic meningitis was observed within the third week after immunisation with Urabe-containing MMR (risk ratio (RR) 14.28; 95% confidence interval (CI) from 7.93 to 25.71) and within the third (RR 22.5; 95% CI 11.8 to 42.9) or fifth (RR 15.6; 95% CI 10.3 to 24.2) weeks after immunisation with the vaccine prepared with the Leningrad-Zagreb strain. A significant risk of association with febrile seizures and MMR exposure during the two previous weeks (RR 1.10; 95% CI 1.05 to 1.15) was assessed in one large person-time cohort study involving 537,171 children aged between three months and five year of age. Increased risk of febrile seizure has also been observed in children aged between 12 to 23 months (relative incidence (RI) 4.09; 95% CI 3.1 to 5.33) and children aged 12 to 35 months (RI 5.68; 95% CI 2.31 to 13.97) within six to 11 days after exposure to MMR vaccine. An increased risk of thrombocytopenic purpura within six weeks after MMR immunisation in children aged 12 to 23 months was assessed in one case-control study (RR 6.3; 95% CI 1.3 to 30.1) and in one small self controlled case series (incidence rate ratio (IRR) 5.38; 95% CI 2.72 to 10.62). Increased risk of thrombocytopenic purpura within six weeks after MMR exposure was also assessed in one other case-control study involving 2311 children and adolescents between one month and 18 years (odds ratio (OR) 2.4; 95% CI 1.2 to 4.7). Exposure to the MMR vaccine was unlikely to be associated with autism, asthma, leukaemia, hay fever, type 1 diabetes, gait disturbance, Crohn's disease, demyelinating diseases, bacterial or viral infections. AUTHORS' CONCLUSIONS The design and reporting of safety outcomes in MMR vaccine studies, both pre- and post-marketing, are largely inadequate. The evidence of adverse events following immunisation with the MMR vaccine cannot be separated from its role in preventing the target diseases.
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Affiliation(s)
- Vittorio Demicheli
- Servizio Regionale di Riferimento per l’Epidemiologia, SSEpi-SeREMI - Cochrane Vaccines Field, Azienda Sanitaria Locale ASL AL,Alessandria, Italy.
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17
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Khan A, Chaudhry AA, Khan U. Falciparum--the masquerader. J PAK MED ASSOC 2012; 62:62-63. [PMID: 22352106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The case of a 23-year-old male presenting with a rash on the chest and lower limbs is presented. Work up revealed bicytopenia and plasmodium falciparum on bone marrow biopsy. Treatment with antimalarial drugs resulted in resolution of haematological abnormalities and rash.
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Affiliation(s)
- Aslam Khan
- Department of Medicine, Combined Military Hospital, Quetta
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18
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Chen XY, Li DY, Xu YM. [Chinese medicine treatment of refractory purpura: its advantages and clinical practice]. Zhongguo Zhong Xi Yi Jie He Za Zhi 2011; 31:1033-1035. [PMID: 21910328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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19
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Sato K, Ozawa K. [The role of Helicobacter pylori infection in hematological diseases - a review]. Gan To Kagaku Ryoho 2011; 38:358-361. [PMID: 21403437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Helicobacter pylori (H. pylori) infection has been known to be the most closely associated with extra-gastrointestinal diseases. Above all, the association between H. pylori and hematological diseases, including immune thrombocytopenic purpura ( ITP), gastric MALT lymphoma and iron deficiency anemia (IDA) has been focused. Although the molecular mechanisms have not yet been fully understood, H. pylori eradication resulted in high response rates without major adverse effects. We focus here on a comprehensive review of the current literature of ITP, gastric MALT lymphoma and IDA.
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Affiliation(s)
- Kazuya Sato
- Division of Hematology, Dept. of Medicine, Jichi Medical University, Japan
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20
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Abstract
We present 2 patients with chronic immune thrombocytopenic purpura (ITP) secondary to Candida albicans infection. Neither patient responded to standard ITP therapy including splenectomy. Appropriate antifungal treatment of the C. albicans infection was followed by sustained improvement in platelet count in both patients. To our knowledge, this is the first report of ITP in association with C. albicans infection.
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Affiliation(s)
- Mahmoud H Ayesh Haj Yousef
- Department of Internal Medicine, King Abdullah University Hospital, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
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21
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Hsieh YL, Lin LH. Thrombocytopenic purpura following vaccination in early childhood: experience of a medical center in the past 2 decades. J Chin Med Assoc 2010; 73:634-7. [PMID: 21145511 DOI: 10.1016/s1726-4901(10)70138-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Accepted: 09/14/2010] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND The etiology of thrombocytopenia during infancy and early childhood may be different from that of older children, because young children frequently receive vaccines. The following study was performed to understand whether there was a causal relationship between vaccinations and thrombocytopenia. METHODS We retrospectively studied, through chart review, the relationship between vaccination and thrombocytopenic purpura in 20 children with thrombocytopenia (platelet count < 150 x 10³/mm³) under the age of 3 years who were hospitalized between 1989 and 2010. Cases with a history of infectious symptoms/signs between vaccination and the occurrence of thrombocytopenia were excluded. Thrombocytopenia cases not diagnosed as idiopathic thrombocytopenic purpura but as post-vaccination thrombocytopenic purpura should have a similar vaccination-to-thrombocytopenia interval as reported in Western journals, but which should not be more than 9 weeks after vaccination. RESULTS Of the 20 cases of thrombocytopenic purpura, 12 followed vaccination and 8 were considered idiopathic. Of the 12 post-vaccination cases, 5 occurred after the second dose of hepatitis B virus vaccine at 1 month of age, 4 occurred after the first dose of diphtheria-tetanus-acellular pertussis-containing vaccine at 2-3 months of age, 2 occurred after the first dose of measles-mumps-rubella vaccine at 16 months of age, and 1 occurred after the first dose of varicella vaccine at 14 months of age. One of these 12 cases, who also had a marked decrease in hemoglobin level without bleeding, was suspected to have Evans syndrome. CONCLUSION Vaccination may be a risk factor for infant thrombocytopenic purpura.
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Affiliation(s)
- Yuh-Lin Hsieh
- Department of Pediatrics, Cathay General Hospital, Taipei, Taiwan, R.O.C
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22
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Cela I, Miller IJ, Katz RS, Rizman A, Shammo JM. Successful treatment of amegakaryocytic thrombocytopenia with eltrombopag in a patient with systemic lupus erythematosus (SLE). Clin Adv Hematol Oncol 2010; 8:806-809. [PMID: 21326158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Iva Cela
- Division of Hematology, Oncology, and Stem Cell Transplantation, Rush University Medical Center, Chicago, IL 60612, USA,
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23
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Farah RA, Hage P, Al Rifai A, Afif C. Immune thrombocytopenic purpura associated with brucellosis. Case report and review of the literature. J Med Liban 2010; 58:241-243. [PMID: 21409948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A case of severe thrombocytopenic purpura as the sole manifestation of brucellosis in an eight-year-old boy is presented. Clinical examination revealed mucosal hemorrhages and splenomegaly. The initial diagnosis was immune thrombocytopenic purpura (ITP) and he received intravenous gamma globulins and steroids with good hematologic and clinical response. His brucella agglutination titer was positive and he received treatment with intravenous gentamicin and oral co-trimoxazole with good response. Although mild hematologic manifestations can be encountered in brucellosis, severe thrombocytopenia is rare. Prompt recognition of this association is essential for early therapy. A brief review of thrombo-cytopenic purpura associated with brucellosis is presented.
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Affiliation(s)
- Roula A Farah
- Department of Pediatrics, St. George Hospital, University of Balamand, Beirut, Lebanon.
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24
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Abstract
Helicobacter pylori infection is implicated in the pathogenesis of extradigestive diseases such as acne rosacea and idiopathic chronic urticaria and autoimmune diseases such as autoimmune gastric atrophy, rheumatoid arthritis, anti phospholipid antibody syndrome, autoimmune thyroiditis, Sjoegren syndrome, Henoch-Schoenlein purpura, and Type B insulin resistance syndrome. H. pylori eradication ameliorated the condition in some, but not all, of those with these autoimmune diseases. Recent studies primarily in Italy and Japan found that H. pylori eradication in those infected with chronic immune thrombocytopenic purpura (ITP) results in a persistent platelet count increase in over half of those treated, suggesting that although pathogenetic mechanisms underlying the relationship between H. pylori infection and autoimmune disease remain unclear, yet-unknown immunological events induced by H. pylori infection almost certainly occur in the development of autoimmune response. A majority of isolated H. pylori strains express human Lewis (Le(x) and/or Le(y) determinants and in some strains, Le(a), Le(b), sialyl-Le(x)), and H determinants in the O-chain of the surface lipopolysaccharide. Previous studies showed that this molecular mimicry helps the bacterium evade host responses while evoking autoantibody responses to Le antigens. The anti-Le(y) autoantibody is also reported to promote H. pylori adhesion to gastric epithelial cells, leading to development of gastric atrophy. Moreover, one can hypothesize that anti-Le autoreactive antibodies induced by H. pylori infection are involved in the development of autoimmune diseases, although no clinical studies showing that anti-Le immune responses are involved in the etiology of these autoimmune diseases have been conducted. Proving this hypothesis would require quantitative and qualitative analysis of autoantibodies and T cell functions to Le antigens. High frequent phase variation of Le structures in the O-polysaccharide of H. pylori may influence the immune response of patients to Le antigens.
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Affiliation(s)
- Michio Ohta
- Department of Bacteriology, Nagoya University Graduate School of Medicine
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25
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Terashita S, Hirano K, Hirai T, Narabayashi T, Hara Y, Endo K, Hirabayashi M. [Successful treatment of small cell lung cancer with secondary immune thrombocytopenic purpura]. Nihon Kokyuki Gakkai Zasshi 2009; 47:1036-1040. [PMID: 19994601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Chest CT on admission of a 58-year-old woman with bloody sputum showed a mass shadow at the hilum of the right lung suggesting invasion to the mediastinum, and contralateral mediastinal lymph node (#6) metastasis. Bronchial brush cytology yielded a diagnosis of small cell lung cancer (SCLC). The clinical stage was T4N3M0, stage IIIB, limited disease (LD). On admission, her platelet count was only 40 x 10(3)/microl. Blood biochemistry and bone marrow puncture revealed immune thrombocytopenic purpura (ITP). We speculated that she had secondary ITP (ITP-like syndrome) associated with cancer. Only 11 cases of lung cancer with secondary ITP have ever been reported, 4 cases of which attained complete response of cancer and complete remission of ITP by anti-cancer therapy. Therapeutic procedures employed were surgery in 3 cases of adenocarcinoma and a high dose chemotherapy (HDC) with autologous peripheral blood stem cell transplantation (APBSCT) in 1 case of SCLC. In the present case, concurrent chemoradiotherapy (four cycles of cisplatin/etoposide (PE) combined with 45Gy of thoracic radiotherapy) was performed, which resulted in a complete response of SCLC and a complete remission of the secondary ITP. This is apparently the first report of successful treatment of SCLC with secondary ITP by standard chemoradiotherapy. In a SCLC patient with ITP-like symptoms, treatment for SCLC may simultaneously resolve the ITP-like symptoms.
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Affiliation(s)
- Satoshi Terashita
- Department of Respiratory Medicine, Hyogo Prefectural Amagasaki Hospital
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Laursen B, Morling N, Rosenkvist J, Sørensen H, Thyme S. Post-transfusion purpura treated with plasma exchange by haemonetics cell separator. A case report. Acta Med Scand 2009; 203:539-43. [PMID: 566507 DOI: 10.1111/j.0954-6820.1978.tb14922.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
A case of post-transfusion purpura in a 61-year-old, multiparous female with a platelet alloantibody (anti-Zwa) in her serum is reported. The patient was successfully treated with plasma exchange by means of a Haemonetics 30 cell separator and corticosteroids. Compared with other therapeutic measures, plasma exchange seems to shorten the duration of thrombocytopenia. Major surgery was possible in our patient within ten days of development of the syndrome.
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27
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Zhang LJ, Zhang Y. [Recent advances of CD4(+)CD25(+) regulatory T cells in pathogenesis of idiopathic thrombocytopenic purpura - review]. Zhongguo Shi Yan Xue Ye Xue Za Zhi 2008; 16:950-953. [PMID: 18718098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
CD4(+)CD25(+) regulatory T cells are thought to be a subgroup of cells which have the function of immune suppression. 5 to 10 percentage of peripheral CD4(+) T cells and 1% - 2% of peripheral mononuclear cells are CD4(+)CD25(+) regulatory T cells in mouse or healthy human. They can suppress immune response through many pathways and sustain the stabilization of internal environment. Idiopathic thrombocytopenic purpura is a kind of autoimmunity disease which mainly has a manifestation of hemorrhage in some locations such as skin, mucosa or viscera. Recent findings support that CD4(+)CD25(+) regulatory T cells are relevant to the morbidity of idiopathic thrombocytopenic purpura. In this review, the recent advance on characteristics and function of CD4(+)CD25(+) regulatory T cells, pathogenesis of idiopathic thromocytopenic purpura and role CD4(+)CD25(+) regulatory T cells in pathogenesis of idiopathic thrombocytopenic purpura were summarized.
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Affiliation(s)
- Lu-Juan Zhang
- Department of Hematology, The second Affiliated Hospital, Kunming 650101, Yunnan Province, China
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28
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Moffat EH, Gerrish P, Mir MA, Darke C. Remission of post-transfusion thrombocytopenic purpura with high dose intravenous corticosteroids. Clin Lab Haematol 2008; 4:333-6. [PMID: 6891915 DOI: 10.1111/j.1365-2257.1982.tb00475.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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29
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Palumbo E, Sodini F, Boscarelli G, Nasca G, Branchi M, Pellegrini G. Immune thrombocytopenic purpura as a complication of Bartonella henselae infection. Infez Med 2008; 16:99-102. [PMID: 18622151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Immune thrombocytopenic purpura is an infrequent yet well-recognized complication of viral infections, such as mumps, rubella, varicella, cytomegalovirus, parvovirus and infectious monunucleosis by Epstein-Barr virus. Some recent studies have described a possible association between Henoch-Schonlein purpura, a non-thrombocytopenic purpura, and seropositivity for Bartonella henselae, but in the literature only sporadic case reports have described a severe immune thrombocytopenic purpura as a complication of Bartonella henselae infection. We report a case of an immunocompetent child with clinical and serological evidence of Bartonella henselae infection presenting with purpura and cervical lymphoadenopathy and treated with intravenous immunoglobulin. The patient obtained a rapid and persistent increase in platelet count and a complete regression of purpura.
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Affiliation(s)
- Emilio Palumbo
- Dipartimento di Pediatria, Ospedale di Sondrio, Sondrio, Italy
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30
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Tuon FF, Higashino HR, Amato VS, Nicodemo AC. Acute immune-mediated thrombocytopenic purpura related to Toxoplasma gondii infection. Int J Infect Dis 2008; 12:671-2. [PMID: 18372206 DOI: 10.1016/j.ijid.2007.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2007] [Revised: 12/05/2007] [Accepted: 12/07/2007] [Indexed: 11/29/2022] Open
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Khadwal A, Deepthi N. Severe thrombocytopenia in a child with type 1 diabetes. Pediatr Endocrinol Diabetes Metab 2008; 14:125-126. [PMID: 18721501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
We describe here a young girl who developed severe thrombocytopenia following Varicella infection. She was previously diagnosed with diabetes. In addition she demonstrated anti-nuclear factor positivity. Immune thrombocytopenic purpura induced by varicella is rare in children with diabetes.
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Affiliation(s)
- Alka Khadwal
- Department of Pediatrics, Advanced Pediatric Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Abstract
UNLABELLED The HPA-15 platelet (PLT) group was recently described. Severe neonatal thrombocytopenia due to alloimmunization by HPA-15b has very rarely been observed. A 22-year-old mother, gravida 1/para 1, gave birth to a male infant who presented with a severe thrombocytopenia, the PLT count recorded to be 3 x10(9)/L. A few hours after birth, he developed purpura with extensive haematomas but without visceral or intracranial haemorrhage (ICH). Two PLT transfusions were given including one using maternal PLTs. The infant's PLT count was 267 x 10(9)/L on day 6. The maternal platelet group was HPA-15a/a and her infant was HPA-15a/b. Anti-HPA-15b antibodies was found in maternal serum. CONCLUSION HPA-15b maternal alloimmunization may induce severe neonatal thrombocytopenia. In order to establish the frequency of neonatal alloimmune thrombocytopenia (NAIT) due to anti-HPA-15b antibodies, an improved detection method is necessary.
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MESH Headings
- Adult
- Antigens, CD/blood
- Antigens, CD/immunology
- Antigens, Human Platelet/blood
- Antigens, Human Platelet/immunology
- Blood Group Incompatibility/complications
- Blood Group Incompatibility/diagnosis
- Blood Group Incompatibility/therapy
- Cesarean Section
- Female
- GPI-Linked Proteins
- Humans
- Infant, Newborn
- Male
- Maternal-Fetal Exchange/immunology
- Neoplasm Proteins/blood
- Neoplasm Proteins/immunology
- Platelet Transfusion
- Pregnancy
- Pregnancy Complications, Hematologic/immunology
- Purpura, Thrombocytopenic/etiology
- Thrombocytopenia, Neonatal Alloimmune/diagnosis
- Thrombocytopenia, Neonatal Alloimmune/immunology
- Thrombocytopenia, Neonatal Alloimmune/therapy
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Affiliation(s)
- P Moncharmont
- French Blood Establishment, Rhône-Alpes Lyon Department, Lyon, France.
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Forster LM. Neonatal alloimmune thrombocytopenia, purpura, and anemia in 6 neonatal piglets. Can Vet J 2007; 48:855-7. [PMID: 17824332 PMCID: PMC1914324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
A hemorrhagic diathesis due to neonatal alloimmune thrombocytopenia occurred in a sow herd consisting of F I large white X Landrace females. Colostrum, containing maternal antibodies incompatible with platelet antigens inherited from the sire, was ingested and absorbed by the piglets. Six piglets were affected and displayed signs of lethargy and depression with petechiation, ecchymosis, and severe bruising of the skin. All 6 piglets died or were euthanized by 3 days of age.
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Affiliation(s)
- Lorraine M Forster
- Large Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, 52 Campus Drive, Saskatoon, Saskatchewan
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Abstract
The prevalence, incidence and outcomes of haemolytic uraemic syndrome (HUS) and thrombotic thrombocytopaenic purpura (TTP) are not well established in adults or children from prospective studies. We sought to identify both outcomes and current management strategies using prospective, national surveillance of HUS and TTP, from 2003 to 2005 inclusive. We also investigated the links between these disorders and factors implicated in the aetiology of HUS and TTP including infections, chemotherapy, and immunosuppression. Most cases of HUS were caused by verocytotoxin-producing Escherichia coli (VTEC), of which serotype O157 predominated, although other serotypes were identified. The list of predisposing factors for TTP was more varied although use of immunosuppressive agents and severe sepsis, were the most frequent precipitants. The study demonstrates that while differentiating between HUS and TTP is sometimes difficult, in most cases the two syndromes have quite different predisposing factors and clinical parameters, enabling clinical and epidemiological profiling for these disorders.
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Hashino S. [Heliobacter pylori-related thrombocytopenic purpura]. Nihon Saikingaku Zasshi 2006; 61:381-9. [PMID: 17191693 DOI: 10.3412/jsb.61.381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Affiliation(s)
- Satoshi Hashino
- Department of Gastroenterology and Hematology, Hokkaido University Graduate School of Medicine
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Fernández Barrio B, Santos-Juanes Jiménez J, Suárez Saavedra S, Medina Villanueva A, Concha Torre A, Sánchez del Río J, Rey Galán C. [Complications of varicella for which dermatologists are rarely consulted, another argument in favor of systematic immunization]. Actas Dermosifiliogr 2006; 97:291-2. [PMID: 16801030 DOI: 10.1016/s0001-7310(06)73405-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Abstract
Neonatal alloimmune thrombocytopenia (NAIT) occurs when maternal alloantibodies to antigens presented on foetal platelets cause their immune destruction. Whether human leucocyte antigen (HLA) antibodies can cause NAIT is controversial. Here, a patient was described who suffered from a NAIT caused by an HLA-B27 antibody. Sera from the mother and the newborn were tested for human platelet antigen antibodies and HLA antibodies by monoclonal antibody-specific immobilization of platelet antigens (MAIPA) assay, solid phase-linked immunosorbent assay (ELISA), lymphocytotoxicity assay (LCT) and flow cytometric analysis. No antibodies against cluster designation (CD)109 and platelet glycoproteins of the father were found in patient's and mother's serum. However, HLA ELISA was used to identify HLA antibody in both sera. The antibody was specified as HLA-B27 antibody. Typing results showed that the father descended HLA-B27 antigen on patient and his brother. The mother was HLA-B27 negative. It is most conceivable that the previous pregnancy of the mother induced the production of anti-HLA-B27 antibody, which crossed the placenta and subsequently caused an NAIT in the case presented.
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Affiliation(s)
- H Thude
- Institute for Transfusion Medicine, University Hospital of Jena, Jena, Germany.
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Abstract
The self-controlled case series method was developed to investigate associations between acute outcomes and transient exposures, using only data on cases, that is, on individuals who have experienced the outcome of interest. Inference is within individuals, and hence fixed covariates effects are implicitly controlled for within a proportional incidence framework. We describe the origins, assumptions, limitations, and uses of the method. The rationale for the model and the derivation of the likelihood are explained in detail using a worked example on vaccine safety. Code for fitting the model in the statistical package STATA is described. Two further vaccine safety data sets are used to illustrate a range of modelling issues and extensions of the basic model. Some brief pointers on the design of case series studies are provided. The data sets, STATA code, and further implementation details in SAS, GENSTAT and GLIM are available from an associated website.
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Affiliation(s)
- Heather J Whitaker
- Department of Statistics, The Open University, Milton Keynes, MK7 6AA, UK.
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Abstract
Acquired amegakaryocytic thrombocytopenia is an unusual hematologic disorder characterized by thrombocytopenia in association with markedly diminished bone marrow megakaryocytes. We report a case that responded to treatment with cyclosporine but not to IL-11. The bone marrow biopsy, repeated after resolution of thrombocytopenia, showed normal number of megakaryocytes.
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Affiliation(s)
- Neeraj Agarwal
- Division of Hematology, Department of Internal Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah 84132, USA
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40
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Abstract
A 22-year-old woman was admitted into our hospital because of generalized purpura and abnormalities in her chest X-ray. Isolated thrombocytopenia and elevated platelet-associated IgG levels were detected, while the bone marrow examination was normal. Mycobacterium tuberculosis was detected in the bronchoalveolar lavage fluid, and consequently she was diagnosed as having active tuberculosis. High-dose immunoglobulin therapy combined with anti-tuberculosis drugs not only rapidly and continuously corrected thrombocytopenia but also cured pulmonary tuberculosis. This case suggests a causal association between immune thrombocytopenia and tuberculosis as well as the safety and efficacy of the anti-tuberculosis drugs combined with high-dose immunoglobulin therapy.
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Affiliation(s)
- Kiminori Tsuro
- Department of Gastroenterology and Metabology, Toon, Ehime University Graduate School of Medicine
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41
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Altuntas F, Yildiz O, Sari I, Eser B, Cetin M, Unal A. Intravenous gamma globulin is effective as an urgent treatment in Brucella-induced severe thrombocytopenic purpura. Am J Hematol 2005; 80:204-6. [PMID: 16247741 DOI: 10.1002/ajh.20386] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Severe thrombocytopenia is a rare hematologic manifestation of brucellosis, which can occasionally be associated with bleeding into the skin and from mucosal sites. Prompt recognition of this brucellosis complication and aggressive therapy is vital because the mortality rate associated with bleeding into the central nervous system is high. We report a case of a patient infected with Brucella melitensis who was admitted with a severe case of thrombocytopenic purpura. The patient responded well to intravenous gamma globulin (IVIg) treatment with platelet recovery within 2-3 days. For cases of Brucella-induced thrombocytopenic purpura, IVIg may be administered as an urgent therapy until the microbial therapy takes effect.
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Affiliation(s)
- Fevzi Altuntas
- Department of Hematology, Erciyes University, Faculty of Medicine, Kayseri, Turkey.
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42
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Bierling P. [Thrombocytopenia]. Rev Prat 2005; 55:1355-61. [PMID: 16138604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Philippe Bierling
- Laboratoire d'Immunologie Leucoplaquettaire, EFS lle-de-France, Hôpital Henri Mondor, 94000 Créteil.
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43
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Shenoy VV, Joshi SR, Duberkar D, Kadam KN, Shedge RT, Lanjewar DN. Kaposi's sarcoma with thrombocytopenia in a heterosexual Asian Indian male. J Assoc Physicians India 2005; 53:486-8. [PMID: 16124362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
A 45-year-old heterosexual male patient with retroviral disease since 12 years presented with hyperpigmented lesions, misdiagnosed initially as purpura due to an associated thrombocytopenia, but was biopsy proven to be Kaposi's sarcoma (KS). Bone marrow examination revealed excess megakaryocytes. Low CD4 count and absence of platelet specific IgG reduced the likelihood of immune thrombocytopenia (ITP). However after 6 weeks of antiretroviral therapy the patient's lesions have reduced and platelet counts are improving, possibly suggesting a sequestration thrombocytopenia in the abnormal tumor vessels of KS.
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Affiliation(s)
- V V Shenoy
- Department of Medicine, Grant Medical College and Sir J. J. Group of Govt. Hospital, Mumbai
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44
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Tourneux P, Jouvencel P, Micheau M, Jouvencel AC, Chateil JF, Barba G, Letavernier B, Llanas B. [Parvovirus B19 thrombocytopenic purpura complicated with a cerebral hemorrhage]. Arch Pediatr 2005; 12:281-3. [PMID: 15734124 DOI: 10.1016/j.arcped.2004.11.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2003] [Accepted: 11/12/2004] [Indexed: 10/25/2022]
Abstract
UNLABELLED Severe hemorrhage complications are rare in idiopathic thrombocytopenic purpura. This pathology is often considered as benign. CASE REPORT We report the case of a four-year-old boy presenting a parvovirus B19 idiopathic thrombocytopenic purpura. Despite early and repeated use of intravenous immunoglobulin, the evolution was characterized by the secondary apparition of a cerebral hemorrhage. It was lethal seven days after the initial diagnosis. CONCLUSION Parvovirus B19 should be investigated as an etiologic agent of idiopathic thrombocytopenic purpura, using PCR. The unpredictive aspect of severe hemorrhage complications, especially cerebral hemorrhages, explains the potential severity of this disease.
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Affiliation(s)
- P Tourneux
- Service de médecine néonatale et réanimation pédiatrique polyvalente, CHU d'Amiens, hôpital Nord, 1, place Victor-Pauchet, 80054 Amiens cedex 1, France.
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45
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Kaneko H, Ohkawara Y, Nomura K, Horiike S, Taniwaki M. Relapse of idiopathic thrombocytopenic purpura caused by influenza A virus infection: a case report. J Infect Chemother 2005; 10:364-6. [PMID: 15614463 DOI: 10.1007/s10156-004-0343-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2004] [Accepted: 09/06/2004] [Indexed: 10/26/2022]
Abstract
We report a patient with idiopathic thrombocytopenic purpura (ITP) in remission, who relapsed as a result of an influenza A virus infection. A 41-year-old woman presented with fever elevation, coughing, and generalized petechiae. Her platelet count had decreased to 1 x 10(9)/l. She had been diagnosed with ITP at age 23, and continuous complete remission had followed steroid therapy and splenectomy. Influenza A antigen was positive in her pharyngeal aspirate, and oseltamivir was effective for her symptoms. Findings of a bone marrow smear were typical for ITP. Steroid therapy resulted in a second complete remission. Although the development of ITP caused by influenza infection and a relapse caused by an influenza vaccination have been previously described, a relapse caused by a sporadic infection has never been documented to our knowledge. Physicians should carefully monitor the hematological data of influenza patients, especially those with ITP, even in remission.
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Affiliation(s)
- Hiroto Kaneko
- Department of Hematology, Aiseikai Yamashina Hospital, 19-4 Takehana Shichouno-cho, Yamashina-ku, Kyoto 607-8086, Japan.
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46
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Carbone J, Sarmiento E, Rodríguez-Molina JJ, Fernández-Cruz E. [Atypical presentation of common variable immunodeficiency without infections]. Allergol Immunopathol (Madr) 2004; 32:218-22. [PMID: 15324652 DOI: 10.1016/s0301-0546(04)79242-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Common variable immunodeficiency (CVID) is a primary immunodeficiency disease, the hallmark of which is hypogammaglobulinemia and poor specific antibody responses. Patients usually have recurrent bacterial infections, but there are a number of other comorbid disorders, including autoimmune disease and neoplasms. Most patients are diagnosed as adults, and delay in identifying the antibody defect is common. In the present report, we illustrate atypical initial presentation without infections in CVID. CLINICAL OBSERVATION In 5 out of 30 patients with CVID (16.6 %) diagnosed in our hospital in the Autonomous Community of Madrid, the first manifestation of immunodeficiency was not an infection. Three patients presented with immune cytopenias (thrombocytopenic purpura [n = 2] and hemolytic anemia [n = 1]); one patient had pernicious anemia and one patient had insulin-dependent diabetes as the first clinical feature of CVID. Four patients had IgG levels below 400 mg/dl. CONCLUSIONS Atypical presentations of CVID must be recognized to prevent delayed diagnosis. Presentation of CVID as an autoimmune disease in the absence of recurrent infections prompts us to suggest baseline testing of immunoglobulin levels in patients presenting with autoimmune disorders.
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Affiliation(s)
- J Carbone
- Unidad de Inmunología Clínica, Servicio de Inmunología, Hospital General Universitario Gregorio Marañón, Spain.
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47
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Tang HF, Zhou YY, Gu WZ, Li MJ. [Clinicopathologic features of kaposiform hemangioendothelioma]. Zhonghua Wai Ke Za Zhi 2004; 42:1132-5. [PMID: 15498303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
OBJECTIVE To explore the clinicopathologic features of kaposiform hemangioendothelioma (KHE). METHODS The clinicopathologic data were studied in three cases of KHE and review the literatures. RESULTS Two cases were female and one was male. All cases occurred in infancy. Two tumor located in axillary chest wall and one in lumbar region. All of the three patients had Kasabach-Merritt syndrome. Histologically, the tumor was composed of spindle-shaped cells. in all cases nodular growth pattern was seen. Immunohistochemically, Neoplastic spindled cells expressed CD34 and CD31. Associated lymphangiomatosis was present in two cases. Two tumors were resected completely, one was resected partly. the follow-up period ranged from 6 months to 3 years, and all were alive. CONCLUSIONS Kaposiform hemangioendothelioma is a rare locally aggressive vascular tumor that mainly occurred in early infancy. It is frequently complicated by Kasabach-Merritt syndrome, and it has features common to both capillary hemangioma and Kaposi sarcoma. The prognosis of KHE is determined by the size, location and the hemorrhage degree of vascular tumor. Better outcome might be achieved in patients with KHE of the skin and in the soft tissues under the skin. It appears that the main treated measure should be wide local excision.
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Affiliation(s)
- Hong-feng Tang
- Department of Pathology, Children's Hospital, Zhejiang University College of Medicine, Hangzhou 310003, China
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48
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Mohanty D, Kulkarni B, Ghosh K, Nair S, Khare A. Human platelet specific antigens and their importance. Indian Pediatr 2004; 41:797-805. [PMID: 15347867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Affiliation(s)
- Dpika Mohanty
- Institute of Immunohematology (ICMR), 13th Floor, KEM Hospital New Building, Parel, Mumbai 400012, India.
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49
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Yalaz M, Arslan MT, Kurugöl Z. Thrombocytopenic purpura as only manifestation of brucellosis in a child. Turk J Pediatr 2004; 46:265-7. [PMID: 15503483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Thrombocytopenic purpura associated with brucellosis has been rarely reported in the world literature. Thrombocytopenic purpura is generally part of the array of manifestations of brucellosis such as fever, arthritis, malaise and hepatosplenomegaly. We describe a nine-year-old girl who presented with thrombocytopenic purpura as the sole manifestation of brucellosis, which resolved with anti-Brucella chemotherapy. Her physical examination was remarkable for hepatomegaly of 3 cm and splenomegaly of 2 cm palpable below the costal margin. Initial laboratory investigations revealed isolated thrombocytopenia with platelet count of 11,300/mm3 and positive serology for Brucella. Thrombocytopenia resolved promptly with proper antibiotics on 7th day of treatment. Brucellosis should be included in the differential diagnosis of thrombocytopenic purpura in Brucella-endemic areas.
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Affiliation(s)
- Mehmet Yalaz
- Department of Pediatrics, Ege University Faculty of Medicine, Izmir, Turkey
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50
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de la Torre AN, Fisher A, Wilson DJ, Harrison J, Koneru B. A CASE REPORT OF DONOR TO RECIPIENT TRANSMISSION OF SEVERE THROMBOCYTOPENIA PURPURA. Transplantation 2004; 77:1473-4. [PMID: 15167613 DOI: 10.1097/01.tp.0000122417.61345.2d] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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