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Home All Specialties Oncology

Isolated thrombocytopenia uncommon in children treated for ALL [Pediatrics Classics Series]

byLeah Carr, MDandLewis First, MD
August 14, 2014
in Oncology, Pediatrics, Pediatrics Classics, The Classics
Reading Time: 2 mins read
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1. Among 2239 pediatric patients diagnosed with acute lymphoblastic leukemia, no child met criteria for isolated thrombocytopenia as evidenced by complete blood count, peripheral blood smear, and hepatosplenomegaly on physical exam.

Original Date of Publication: December 1989

Study Rundown: Prior to this study’s publication, children with isolated decreases in platelet counts commonly underwent bone marrow aspiration/biopsy in order to assess for potential leukemia before initiating steroid therapy. As bone marrow examination is an invasive procedure, not without its own risks, this study investigated whether or not this was a necessary practice. Through retrospective analysis of forms prior to the start of a leukemia protocol study, researchers found that none of the 2239 pediatric patients included met criteria for “isolated significant thrombocytopenia” at the time of their leukemia diagnosis. This study is limited by its retrospective nature. Based on this research, investigators concluded that with confirmation of these findings by additional prospective studies, children presenting with likely idiopathic thrombocytopenic purpura (ITP) do not require referral for bone marrow examination. Now, as a result of such studies, children with clear ITP do not undergo bone marrow aspiration and instead are placed on steroid therapy or intravenous immunoglobulin without workup beyond complete blood count (CBC) and physical exam.

Click to read the study in Pediatrics

In-Depth [retrospective cohort study]: Institutions participating in 2 Pediatric Oncology Group acute lymphoblastic leukemia protocols for patients provided prestudy forms from 2239 children with information including the CBC and differential and the presence of hepatosplenomegaly for each patient. The number of patients diagnosed with acute lymphoblastic leukemia and with “isolated significant thrombocytopenia” prior to treatment initiation was then recorded. Isolated thromobocytopenia was defined as a platelet count < 50,000/mm3 without blast cells seen on peripheral blood smear, hemoglobin > 11 g/dL, an absolute neutrophil count (ANC) > 1500/mm3, and no hepatosplenomegaly on physical examination. No children in the study diagnosed with ALL met criteria for “isolated significant thrombocytopenia.”

 © 2012-2014 2minutemedicine.com. All rights reserved. No works may be reproduced without expressed written consent from 2minutemedicine.com. Disclaimer: We present factual information directly from peer reviewed medical journals. No post should be construed as medical advice and is not intended as such by the authors, editors, staff or by 2minutemedicine.com. PLEASE SEE A HEALTHCARE PROVIDER IN YOUR AREA IF YOU SEEK MEDICAL ADVICE OF ANY SORT. 

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