Do you have any new pathogenesis of ITP in pediatric age group.
In approximately 60 percent of cases, antibodies against platelets can be detected. Most often these antibodies are against platelet membrane glycoproteins IIb-IIIa or Ib-IX, and are of the immunoglobulin G (IgG) type. Some renowned research, the Harrington–Hollingsworth experiment, established the immune pathogenesis of ITP.
The coating of platelets with IgG renders them susceptible to opsonization and phagocytosis by splenic macrophages, as well by Kupffer cells in the liver. The IgG autoantibodies are also thought to damage megakaryocytes, the precursor cells to platelets, although this is believed to contribute only slightly to the decrease in platelet numbers. Recent research now indicates that impaired production of the glycoprotein hormone thrombopoietin, which is the stimulant for platelet production, may be a contributing factor to the reduction in circulating platelets. This observation has led to the development of a class of ITP-targeted drugs referred to as thrombopoietin receptor agonists.
The stimulus for auto-antibody production in ITP is probably abnormal T cell activity.
Dear Abdul Khaleque
Thank you very much for your nice answer.
Does Rituximab has any role in the management of pediatric patients?
Some references in ITP in childhood
1. Blanchette VS, Carcao M. Childhood acute immune thrombocytopenic purpura: 20 years later (review). Semin Thromb Hemost. 2003;29:605-617.
2. Buchanan GR. Thrombocytopenia during childhood: what the pediatrician needs to know. Pediatr Rev. 2005;26:401-409. 3. Tarantino M. The treatment of immune thrombocytopenic purpura in children. Curr Hematol Rep. 2006;5:89-94.
4. Chandra J, Ravi R, Singh V, Narayan S, Sharma S, Dutta AK. Bleeding manifestations in severely thrombocytopenic children with immune thrombocytopenic purpura. Hematology. 2006;11:131-133.
5. Jadavji T, Scheifele D, Halperin S. Thrombocytopenia after immunization of Canadian children, 1992 to 2001. Pediatr Infect Dis J. 2003;22:119-122.
6. Mouzaki A, Theodoropoulou M, Gianakopoulos I, Vlaha V, Kyrtsonis MC, Maniatis A. Expression patterns of Th1 and Th2 cytokine genes in childhood idiopathic thrombocytopenic purpura (ITP) at presentation and their modulation
by intravenous immunoglobulin G (IVIg) treatment: their role in prognosis. Blood. 2002;100:1774-1779.
7. Foster CB, Zhu S, Erichsen HC, et al; Early Chronic ITP Study Group. Polymorphisms in inflammatory cytokines and Fcgamma receptors in childhood chronic immune thrombocytopenic purpura: a pilot study.Br J Haematol. 2001;113:596-599.
8. Sood R, Wong W, Jeng M, Zehnder JL. Gene expression profile of idiopathic thrombocytopenic purpura (ITP). Pediatr Blood Cancer. 2006;47:675-677.
9. Wu KH, Peng CT, Li TC, et al. Interleukin 4, interleukin 6 and interleukin 10 polymorphisms in children with acute and chronic immune thrombocytopenic purpura. Br J Haematol. 2005;128:849-852.
10. Liu F, Wu C, Yang X, et al. Polarization and apoptosis of T cell subsets in idiopathic thrombocytopenic purpura. Cell Mol Immunol. 2005;2:387-392.
11. Olsson B, Andersson PO, Jacobsson S, Carlsson L, Wadenvik H. Disturbed apoptosis of T-cells in patients with active idiopathic thrombocytopenic purpura. Thromb
Haemost. 2005;93:139-144.
12 Shad AT, Gonzalez CE, Sandler SG. Treatment of immune thrombocytopenic purpura in children: current concepts (review). Paediatr Drugs. 2005;7:325-336.
13. Dickerhoff R, vonRuecker A. The clinical course of immune thrombocytopenic purpura in children who did not receive intravenous immunoglobulins or sustained prednisone treatment. J Pediatr. 2000;137:629-632.
14. Tarantino M. On the conservative management of acute immune thrombocytopenia in children. J Pediatr. 2001;138:787-788.
15. George JN. Initial management of immune thrombocytopenic purpura in children: Is supportive counseling without therapeutic intervention sufficient? J Pediatr. 2000;137:598600.
The attached file will give you a comprehensive platform to how understand and approach patients with ITP. Hope you'll find it useful.
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