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When and how to treat childhood immune thrombocytopenia

doi: 10.1097/01.NPR.0000488684.64778.55
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INSTRUCTIONS When and how to treat childhood immune thrombocytopenia


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Lippincott Williams & Wilkins, publisher of The Nurse Practitioner journal, will award 2.0 contact hours for this continuing nursing education activity.

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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.

  1. In general, which statement about ITP is accurate?
    1. It affects males to females at a ratio of 2:1.
    2. It is a benign, self-limiting phenomenon.
    3. Its peak incidence is in children ages 10 to 12.
  2. Most cases of childhood ITP resolve within the first
    1. 2 months.
    2. 6 months.
    3. year.
  3. Persistent ITP is defined as ITP
    1. in the first 3 months after diagnosis.
    2. between 3 and 12 months after diagnosis.
    3. lasting more than 12 months after diagnosis.
  4. In 72% of newly diagnosed cases, the autoimmune reaction of ITP can be linked to
    1. a preceding illness.
    2. a recent injury.
    3. an episode of bleeding (for example, epistaxis).
  5. In ITP, platelets opsonized by IgG are cleared prematurely and at an accelerated rate by macrophages in the
    1. spleen.
    2. liver.
    3. bone marrow.
  6. The author notes that ITP may be triggered in children ages 1 to 3, especially after vaccination with
    1. diphtheria-pertussis-tetanus.
    2. pneumococcal vaccine.
    3. MMR.
  7. In the 2008 study by Arnold and colleagues, children with secondary ITP related to pylori infection were treated successfully
    1. with one dose of IVIG.
    2. through eradication of the bacteria.
    3. with a taper of oral corticosteroids.
  8. Key findings in an ITP workup include a
    1. family history of bleeding disorders.
    2. gradual onset.
    3. generally well-appearing child.
  9. Lab analysis for a child with ITP reveals
    1. a platelet count of 110,000/mcL or less.
    2. hemolytic anemia if there was significant blood loss.
    3. isolated thrombocytopenia with no other cell lines affected.
  10. A patient is at higher risk for complications from ITP in the presence of
    1. petechiae.
    2. bleeding gums.
    3. bruising.
  11. Which age group is at an increased risk for fatal bleeds from ITP?
    1. toddlers
    2. school-age children
    3. adolescents
  12. As noted in the article, diagnosis of ITP generally is made via history, physical exam, and
    1. bone marrow aspirates.
    2. a compete blood cell count.
    3. splenic ultrasound.
  13. Children with ITP without bleeding are managed with
    1. observation alone.
    2. corticosteroids.
    3. anti-D immunoglobulin.
  14. A potential adverse reaction from anti-D immunoglobulin treatment is
    1. progressive multifocal leukoencephalopathy.
    2. decreased vertical growth.
    3. disseminated intravascular coagulation.
  15. Which statement is correct regarding the off-label use of rituximab to treat persistent ITP?
    1. Without spontaneous remission, children will need multiple treatments.
    2. It is associated with fewer than three adverse reactions in children.
    3. The platelet count will rise within a few days.
  16. 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?
    1. romiplostim
    2. eltrombopag
    3. high-dose dexamethasone
  17. At diagnosis, common findings associated with chronic ITP include
    1. initial age 6 or older.
    2. the presence of other autoimmune diseases.
    3. male gender.
  18. Romiplostim for the treatment of ITP works by
    1. increasing platelet production.
    2. decreasing the production of autoantibodies.
    3. stunting endogenous TPO activity.


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