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  3. Comparison of treatment course and prognosis of children with ITP in Hazrat Masoumeh Hospital in 2008 to 2011

Comparison of treatment course and prognosis of children with ITP in Hazrat Masoumeh Hospital in 2008 to 2011

Number of pages: 56 File Format: word File Code: 31908
Year: 2013 University Degree: Master's degree Category: Medical Sciences
Tags/Keywords: Bleeding diseases - Children with ITP - garlic therapy - Idiopathic thrombocytopenic purpura - IVIG - platelet - Prognosis - Thrombocytopenic
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  • Summary of Comparison of treatment course and prognosis of children with ITP in Hazrat Masoumeh Hospital in 2008 to 2011

    Dissertation

    To obtain the degree of Doctor of Medicine (MD)

    Abstract:

    Objective: This study was conducted in order to compare the course of treatment and prognosis of children with idiopathic thrombocytopenic purpura (ITP) in Hazrat Masoumeh Hospital in 2008-2011.

    Study method: This study was conducted as a cross-sectional descriptive observational study on 100 patients from the hospital and clinic files of children with ITP in Hazrat Masoumeh Hospital in 1988-1991.

    Findings: 59.8% of the cases had severe disease and 80.3% of the children had acute disease. 51.5% of patients received intravenous immunoglobulin with methylprednisolone and 41.4% only received intravenous immunoglobulin. The only thing that was related to the progress of the disease was the number of platelets of the examined patients (P=0.0001).

    Conclusion: In the end, based on the results of this study and their comparison with other similar studies conducted in this field, it is concluded that the course of the disease is acute in 80% of cases and no factor, especially the type of treatment, has an effect on it.

    Keywords: treatment, prognosis, children, ITP

    Introduction:

    Problem statement: Idiopathic thrombocytopenic purpura (ITP) is one of the most common bleeding diseases in childhood. In most cases, the disease presents with diffuse petechiae and purpura. It seems that the cause of the disease is the destruction of platelets by the immune system. This disease can be self-limiting or progress to a chronic condition (1).

    Studies have shown that its incidence in children is 6.4 cases per 100,000 people per year (2, 3). The disease can be acute or chronic. When the platelet count remains low for more than 6 months, it is considered a chronic disease. Research has shown that in chronic ITP, patients are older and the onset of the disease is silent. 50-60% of ITP sufferers show a history of viral infection from 1-3 weeks before getting ITP, and when the disease occurs, most of the sufferers are cleared of viral symptoms (4). This disease is mostly seen in the age group of two to five years, but it can be seen in all age groups (5).

    Several treatments have been proposed for this disease, and different effects have been mentioned in different studies. These treatments include drug treatments (prednisolone, Rogam, IVIG) and surgical treatment (splenectomy) (4). Several researches have been conducted in recent decades on the prevalence, diagnosis and treatment of idiopathic thrombocytopenic purpura, but the field is still open for further investigation and identification of predictive factors. About the predisposing factors to chronic disease in various studies, old age and female gender and silent onset of the disease have been discussed (6 and 7). Therefore, the purpose of this study was to examine the course of the disease and prognosis in patients with ITP in the children's hospital in Qom between 1988 and 1991.

    Research:

    A - The main goal of the plan:

       To determine the course of treatment and prognosis of children with ITP in Hazrat Masoumeh Hospital in 1988 to 1991

    B- Sub-objectives of the project:

    Determining the gender distribution of children with ITP in Hazrat Masoumeh Hospital in 88-91

    Determining the age distribution of children with ITP in Hazrat Masoumeh Hospital in 88-91

    Determining the rate of death in children with ITP in Hazrat Masoumeh Hospital in 1988 to 1991

    Determining the rate of testing in children with ITP in Hazrat Masoumeh Hospital in 1988 to 1991 based on age

    Determining the testing rate in children suffering from ITP in Hazrat Masoumeh Hospital in 1988 to 1991 based on gender

    Determining The rate of testing in children with ITP in Hazrat Masoumeh Hospital in 1988-1991 based on the type of initial manifestation of the disease

    Determining the response to treatment in children with ITP in Hazrat Masoumeh Hospital in 1988-1991 on the 3rd or 5th day of starting treatment

    Comparison of the response to treatment in children with ITP in Hazrat Masoumeh Hospital In 1988 to 1991 based on receiving IVIG and IVIG + Methyl prednisolone

    Determining the rate of complications in children with ITP in Hazrat Masoumeh Hospital in 1988 to 1991 based on the initial platelet count rtl;">Determining the rate of disease complications in children with ITP in Hazrat Masoumeh Hospital in 1988 to 1991 based on age

    Determining the rate of disease complications in children with ITP in Hazrat Masoumeh Hospital in 1988 to 1991 based on gender

    Determining the rate of disease complications in children with ITP in Hazrat Masoumeh Hospital in 1988 to 1991 Based on the initial platelet count

    Determining the duration of treatment for children with ITP in Hazrat Masoumeh Hospital in 1988 to 1991

    Determining the distribution of children with ITP in Hazrat Masoumeh Hospital in 1988 to 1991 based on receiving IVIG and IVIG + Methyl prednisolone

    Determining the percentage of recovery in children with ITP in Hazrat Masoumeh Hospital in 1988 to 1991 after 6 months and distribution based on age and sex is

  • Contents & References of Comparison of treatment course and prognosis of children with ITP in Hazrat Masoumeh Hospital in 2008 to 2011

    List:

    Chapter One: Introduction to Research

    Problem Statement

    Research Objectives

    Chapter Two: Knowledge Available in Research

    - Hypothetical Framework

    Etiology

    Clinical Manifestations

    Laboratory Findings

    Differential Diagnosis

    Treatment

    - An overview of studies conducted

    Chapter three: Research methodology

    Chapter four: Research findings

    Chapter five: Discussion

    Chapter six: Conclusions and suggestions

    List of sources

    Charts related to data tables

    Questionnaire

    Source:

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    Terrel DR, Beebe LA, Vesely SK, Neas BR, Segal JB, George JN. The incidence of immune thrombocytopenic purpura in children and adults: a critical review of published reports. Am J hematol. 2010:85:174-80.

    Nelson Textbook of Pediatrics, 476 Platelet and Blood Vessel Disorders, 476.1 Treatment of Idiopathic Thrombocytopenic Purpura. 19th edition.

    Alavi Samin, Malik Fatemeh, Iqbali Aziz, Arzanian Mohammad Taghi, Shamsian Bibi Shahin, Azargashb Azan Elah. Immune thrombocytopenic purpura and associated factors in patients referred to Mufid Children's Hospital during the years 1382-1387, fall of 1388; 6(3 (series 24)):165-173.

    Bani Hashem Abdullah, Hiradfar Simin, Kayani Mohammad Ali. Comparison of therapeutic effect and side effects of prednisolone, intravenous immunoglobulin and anti-Rh antibody in patients with idiopathic thrombocytopenic purpura. Scientific Medical Journal Fall 2016; 6(3 (series 54)):285-289.

    Celik M, Bulbul A, Aydogan G, Tugcu D, Uslu S, Dursun M. Comparison of anti-D immunoglobulin, methylprednisolone, or intravenous immunoglobulin therapy in newly diagnosed pediatric immune thrombocytopenic purpura. J Thromb Thrombolysis. 2012 Sep 6. [Epub ahead of print]

    George JN, El-Harake MA, Aster RH. Thrombocytopenia due to enhanced platelet destruction by immunologic mechanisms. In: Beutler E, Lichtman MA, Coller BS, Kipps TJ, eds. Williams Hematology. 5th ed. New York, NY: McGraw-Hill; 1995:1315-1329.

    Moake JL. Thrombotic thrombocytopenic due to enhanced hemolytic uremic syndrome. Syndrom. Holfman R. Benz Jr El, Sanford JS. Bruice F. Harvey JC. In Hematology basic principle and practice, Churchill Livingstone New York. P 1495-1513.1991

    Guthrie Jr TH, Brannan DP, Prisant LM. Idiopathic thrombocytopenic purpura in the older adult patient. The American journal of the medical sciences. 1988; 296(1):17. Werlhof PG. Opera Omnia. Hanover: Helwing, 1775:748. In: Major RH, editor. Classic Descriptions of Disease. 3rd ed. Springfield, IL: CC Thomas, 1965

    Glanz J, France E, Xu S, Hayes T, Hambidge S. Population-based, multisite cohort study of the predictors of chronic idiopathic thrombocytopenic purpura in children. Pediatrics 2008; 121(3): e506-12

    Zeller B, Rujon fie J. Childhood ITP in the Nordic countries epidemiology and predictors of chronic disease. Acta paediatrica 2005; 94(2): 178-84.

    Pratt EL, Tarantino MD, Wagner D, Hirsch Pescovitz O, Bowyer S, Shapiro AD. Prevalence of elevated antithyroid antibodies and antinuclear antibodies in children with ITP. Am J Hematol 2005; 79(3): 175-9.

    Kalpatthi R, Bussel JB. Diagnosis, pathophysiology and management of children with refractory immune thrombocytopenic purpura. Curr Opin Pediatr 2008; 20(1): 8-16.

    Kuhne T, Imbach P. Management of children with acute and chronic immune thrombocytopentic purpura. Transfusion Science 1998; 19(3) : 26-268.

    Nathan & Oski. Hematology of infancy & childhood, Saunders Elsevier, 1559, 7th edition.

    Imbach P, d'Apuzzo V, Hirt A, Rossi E, Vest M, Barandun S, et al. High-dose intravenousHigh-dose intravenous gamma globulin for idiopathic thrombocytopenic purpura in childhood. Lancet. 1981;1:1228-31.

    Wintrobe MM, Cartwright GE, Palmer JG, Kuhns WJ, Samuels LT. Effect of corticotrophin and cortisone on the blood in various disorders in man. Arch Int Med. 1951;88:310-36.

    George JN, Woolf SH, Raskob GE, Wasser J, Aledort L, Ballem P, et al. Idiopathic thrombocytopenic purpura: a practice guideline developed by explicit methods for the American Society of Hematology. Blood. 1996; 88(1):3-40.

    Patel VL, Mahévas M, Lee SY, et al. Outcomes 5 years after response to rituximab therapy in children and adults with immune thrombocytopenia. Blood. 2012;119(25):5989-95

    Holt D, Brown J, Terrill K, et al. Response to intravenous immunoglobulin predicts splenectomy response in children with immune thrombocytopenic purpura. Pediatrics. 2003;111(1):87-90.

    Hedlund-Treutiger I, Henter JI, Elinder G. Randomized study of IVIg and high-dose dexamethasone therapy for children with chronic idiopathic thrombocytopenic purpura. J Pediatr Hematol Oncol. 2003 Feb;25(2):139-44.

    Hollander LL, Leys CM, Weil BR, Rescorla FJ. Predictive value of response to steroid therapy on response to splenectomy in children with immune thrombocytopenic purpura. Surgery. 2011 Oct;150(4):643-8.

    Benesch M, Kerbl R, Lackner H, et al. Low-dose versus high-dose immunoglobulin for primary treatment of acute immune thrombocytopenic purpura in children: results of a prospective, randomized single-center trial. J Pediatr Hematol Oncol. 2003 Oct;25(10):797-800.

Comparison of treatment course and prognosis of children with ITP in Hazrat Masoumeh Hospital in 2008 to 2011
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