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Primary immune thrombocytopenia is a bleeding diathesis with an unknown etiology in predisposed individuals with immune disturbances. Although it is claimed that children and adults differ in clinical and laboratory aspects, few data exist to corroborate this observation. Our objective was to assess comparative data from children and adults with newly diagnosed immune thrombocytopenia. Clinical and laboratory data of 1, children and adults were extracted from the Pediatric and Adult Registry on Chronic Immune Thrombocytopenia.
The registry represents a prospective cohort of children and adults with newly diagnosed immune thrombocytopenia. Participating investigators registered their patients immediately after the diagnosis using a web based data transfer. Children aged under 16 years were compared with adults aged 16 years and over thomas kuhne partnervermittlung descriptive statistical analyses.
The presenting mean platelet count of children and adults was Co-morbidity was observed in 3. Bone marrow aspiration and laboratory tests antinuclear antibodies, human immunodeficiency and hepatitis C virus were performed more frequently in adults.
Immunoglobulins were used more frequently in children and corticosteroids in adults. Comparative data of children and adults with newly diagnosed immune thrombocytopenia revealed similarities in presenting platelet counts and in bleeding, whereas differences occurred in co-morbidity, diagnostic procedures and therapy.
Immune thrombocytopenia ITPformerly known as idiopathic or immune thrombocytopenic purpura, is an acquired bleeding diathesis resulting from premature frage antwort spiel kennenlernen destruction, reduced platelet production or a combination of both. Secondary ITP assumes the presence of a concurrent underlying disorder responsible for disturbed immune function leading to thrombocytopenia.
The list of such disorders is extensive and may include autoimmune diseases e. Helicobacter pylorithomas kuhne partnervermittlung immunodeficiency virus or hepatitis C virus in addition to many others.
The estimated incidence in children is approximately 1. Due to the rarity of ITP, and the paucity of prospective clinical trial data, the Intercontinental Cooperative ITP Study Group ICIS was founded in by an international panel of hematologists with the goal of establishing a thomas kuhne partnervermittlung network of physicians and researchers to collect data to better define the natural history of childhood ITP, in addition to questions concerning diagnosis and therapy, including early predictors of chronic ITP www.
This international, multi-center registry was designed to collect prospective laboratory and clinical data from children and adults with newly diagnosed ITP and to follow them continuously over time.
The information in the database will be used to compare the laboratory and clinical thomas kuhne partnervermittlung of pediatric and adult ITP, to analyze the heterogeneity and natural history of the disorder across the different age groups, to validate its diagnosis and management, and to identify new patient selection criteria for future trials. This investigation is restricted to the query of the PARC ITP Registry assessing clinical findings at the time of initial diagnosis, with the aim of comparing the differences kennenlernen deutschland children and adults with ITP.
The findings suggest that the differences observed between the two age groups are smaller than expected. Information about the Registry was made available on the internet www.
The ICIS questionnaires are case based, designed to collect prospective clinical and laboratory data at first presentation and throughout the course of ITP, and intended to generate hypotheses with the potential to add side-studies to the main database. Data was submitted electronically directly to the ICIS coordinating office in Basel, Switzerland via the internet to a secure, password protected access site www. Data thomas kuhne partnervermittlung compiled and stored using Microsoft Access The study protocol included the practice guidelines which were published at that time.
The questionnaire included demographic information, date of diagnosis, blood counts at diagnosis, family history of thrombocytopenia, co-morbid conditions none, hypertension, diabetes, gastrointestinal disease, thyroid disease, cancer, alcohol abuse, cardiovascular disease and splenomegalyconcurrent medications none, platelet antagonists, vitamin K antagonists, other anticoagulants, and anti-inflammatory agentsbleeding symptoms, details of laboratory diagnosis, transfusions, splenectomy, and medicinal treatments intravenous immunoglobulins, corticosteroids, anti-D immunoglobulin.
Details of laboratory diagnosis included complete blood counts, whether bone marrow aspiration was performed, and serology for antiphospholipid, antinuclear, and platelet associated antibodies, Thomas kuhne partnervermittlung, hepatitis C and Helicobacter pylori positive or negative test results. The information on methodology for each test was not collected. PARC-ITP represents a registry with prospective observation without protocol based diagnostic or therapeutic interventions.
As it reflects the actual clinical practice of a multinational group of volunteer investigators there is no mechanism guaranteed to provide a balance of the investigated parameters, thus limiting the value of formal statistical tests.
To thomas kuhne partnervermittlung the differences in the medians between the two age groups, the Mann-Whitney U test kennenlernen german used when the data was assumed not to be normally distributed. Due to the characteristics of this analysis, statistical inferences were not made and any P value should only be interpreted thomas kuhne partnervermittlung an indication that the differences between the observed values in each age group reach a level of significance.
The data is presented in this way to enable identification of clinical or laboratory features which may differ in children and adults, and to identify therapies which may be preferred in one group or the other.
At the time of this query, data was provided by 84 investigators representing 74 participating sites in 31 countries see Thomas kuhne partnervermittlung. The number of patients enrolled varied by participating site: Patients were divided into two groups according to age. Children were defined as patients between the age of three months to 16 years, and adults by an age of 16 years or over. The mean age of children was 5. Self-reported ethnic background of the patients is presented in Table 1.
The percentage of adults was higher in Caucasians and smaller in the other groups. In children, the male: In adults, there were more females, with no difference in age between males and females. Co-morbidity was observed in 69 of 1, children 3. More than one co-morbid thomas kuhne partnervermittlung was reported in one child and in 33 adults.
Splenomegaly was reported in 17 children and one adult, challenging the diagnosis of primary ITP. Further details of the co-morbid conditions were not requested.
Patients with a co-morbid condition are described in Table 1. Diabetes, gastrointestinal disease, arterial hypertension and thyroid disease occurred more often in adults. Cancer, cardiovascular disease, and splenomegaly were observed in both age groups at similar frequencies. Concurrently used medications at the time of diagnosis were thomas kuhne partnervermittlung more commonly in adults than children. Nineteen of 1, children were taking anti-inflammatory drugs at the time of diagnosis of ITP.
None were taking platelet antagonists, vitamin K antagonists, or other anticoagulants. In the adults, 17 were prescribed anti-inflammatory medications, 11 platelet antagonists, 4 vitamin K antagonists, and 2 were taking other anticoagulants.
Clinical signs of bleeding were assessed by location no symptoms, cutaneous, oral cavity, thomas kuhne partnervermittlung, menstrual, gastrointestinal, urine, intracranial, muscle, and joint and if the specific bleeding event required medicinal treatment intravenous immunoglobulins, corticosteroids, anti-D or combination therapy Table 2.
Bleeding signs and treatment of children and adults number with percentage in parentheses. Intracranial hemorrhage occurred in 10 of 1, children 0. The mean age of children with intracranial hemorrhage was five years and that of adults was 60 years. The outcome of these patients remains unknown. The mean platelet count at diagnosis was The distribution of the platelet count is shown in Figure 2A.
To compare similarity or dissimilarity of the platelet count distribution between children and adults, a quantile-quantile plot was calculated Figure 2B. A Platelet count of children and adults at the time of ITP diagnosis.
B Platelet counts of children and adults at the time of the diagnosis of ITP are plotted as quantile-quantile thomas kuhne partnervermittlung to compare the distribution of platelet counts of children and adults. With equal size of the number thomas kuhne partnervermittlung observations N for children and adults, each data set is ranked from the smallest to the highest value. If the two distributions are similar, the points occur approximately on the diagonal of the plot. For unequal size of the two data sets interpolation to the same quantile is used.
The choice of diagnostic procedure and frequency of testing differed among children and adults Figure 3. Laboratory test results children vs. Test results are presented in Table 3. Management of children and adults is summarized in Figure 4. Immunoglobulins were used more frequently in children, whereas adults received corticosteroids more frequently.
Percentage of children white bars and thomas kuhne partnervermittlung black bars is shown according to their initial management: The mean age of this sub-group was 6. Intracranial hemorrhage was not observed in this sub-group.
The presenting mean platelet count was Clinical and laboratory youtube facebook wir wollen dich doch nur kennenlernen of children and adults with newly diagnosed ITP have not been studied systematically. Clinical impression and the published literature suggest that there are differences in the clinical and laboratory aspects of pediatric and adult ITP, 68 with variable disease presentations, clinical outcomes, and responses to treatment.
Knowledge of the similarities and differences that may exist have the potential to affect clinical practice and provide a starting point for further study of the underlying etiologies and pathophysiological causes in each age group. The PARC-ITP Registry is the first prospective collection of such clinical data, and the first which allows for direct comparison of the comparative clinical and laboratory characteristics of ITP in children and adults.
Thomas kuhne partnervermittlung the time of this analysis, the majority of the subjects in the Registry were children. The first ICIS registries were exclusively pediatric; consequently there was greater early involvement by pediatric investigators.
However, the pro-portion of adult data being submitted is increasing with time, and it is expected that later queries should reflect a greater balance. Although the adult data represent only a fraction of the total, subjects is a large enough sample size to make valid comparisons to thomas kuhne partnervermittlung much larger pediatric population.
Our data support and confirm some previously reported observations, including the predominance of males in the pediatric age group, whereas female gender dominates among adult patients. Reasons for the observed high proportion of males in childhood ITP remain unknown. An important finding of this analysis is the huge overlap in the clinical and laboratory features of ITP at first diagnosis among children and adults. Although bleeding occurred more frequently in children than in adults, the decision to treat was similar for both age groups.
The severity of bleeding events cannot be compared since bleeding scores were not requested. Not unexpectedly, concurrent use of medication and co-morbid disorders were reported more often for adults.
In both adults and children, thomas kuhne partnervermittlung disease was the most common associated co-morbid condition. Of note, 17 children were reported to have splenomegaly. The presence of co-morbidities, splenomegaly, and positive family history of ITP thomas kuhne partnervermittlung children and adults points to the heterogeneity of ITP and suggests that the classification into primary and secondary ITP needs critical dating lower your standards. With the exception of the high thomas kuhne partnervermittlung of co-morbid conditions in adults, greatest dissimilarities between pediatric and adult ITP were different approaches to diagnostic evaluation and treatment.
Adult patients had laboratory testing more often than children Figure 3. Surprisingly, a similar proportion of children and adults were observed without active treatment, in contrast to previously published reports.
A registry is a scientific tool with advantages and disadvantages. A great advantage of a registry is the ability to use it collaboratively, in a multinational setting, to collect data from a large number of patients with rare disorders in a relatively short interval of time.
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