INSTRUCTIONS When and how to treat childhood immune thrombocytopenia
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When and how to treat childhood immune thrombocytopenia
General Purpose: To provide information on childhood ITP and its treatment. Learning Objectives/Outcomes: After completing this continuing-education activity, you should be able to: 1. Examine the features, pathophysiology, and diagnosis of ITP in children. 2. Select current treatment options for patients with ITP.
- In general, which statement about ITP is accurate?
- It affects males to females at a ratio of 2:1.
- It is a benign, self-limiting phenomenon.
- Its peak incidence is in children ages 10 to 12.
- Most cases of childhood ITP resolve within the first
- 2 months.
- 6 months.
- Persistent ITP is defined as ITP
- in the first 3 months after diagnosis.
- between 3 and 12 months after diagnosis.
- lasting more than 12 months after diagnosis.
- In 72% of newly diagnosed cases, the autoimmune reaction of ITP can be linked to
- a preceding illness.
- a recent injury.
- an episode of bleeding (for example, epistaxis).
- In ITP, platelets opsonized by IgG are cleared prematurely and at an accelerated rate by macrophages in the
- bone marrow.
- The author notes that ITP may be triggered in children ages 1 to 3, especially after vaccination with
- pneumococcal vaccine.
- In the 2008 study by Arnold and colleagues, children with secondary ITP related to pylori infection were treated successfully
- with one dose of IVIG.
- through eradication of the bacteria.
- with a taper of oral corticosteroids.
- Key findings in an ITP workup include a
- family history of bleeding disorders.
- gradual onset.
- generally well-appearing child.
- Lab analysis for a child with ITP reveals
- a platelet count of 110,000/mcL or less.
- hemolytic anemia if there was significant blood loss.
- isolated thrombocytopenia with no other cell lines affected.
- A patient is at higher risk for complications from ITP in the presence of
- bleeding gums.
- Which age group is at an increased risk for fatal bleeds from ITP?
- school-age children
- As noted in the article, diagnosis of ITP generally is made via history, physical exam, and
- bone marrow aspirates.
- a compete blood cell count.
- splenic ultrasound.
- Children with ITP without bleeding are managed with
- observation alone.
- anti-D immunoglobulin.
- A potential adverse reaction from anti-D immunoglobulin treatment is
- progressive multifocal leukoencephalopathy.
- decreased vertical growth.
- disseminated intravascular coagulation.
- Which statement is correct regarding the off-label use of rituximab to treat persistent ITP?
- Without spontaneous remission, children will need multiple treatments.
- It is associated with fewer than three adverse reactions in children.
- The platelet count will rise within a few days.
- What can be used in place of splenectomy in children in the first year of treatment for persistent ITP that is unresponsive to previous therapies?
- high-dose dexamethasone
- At diagnosis, common findings associated with chronic ITP include
- initial age 6 or older.
- the presence of other autoimmune diseases.
- male gender.
- Romiplostim for the treatment of ITP works by
- increasing platelet production.
- decreasing the production of autoantibodies.
- stunting endogenous TPO activity.