Immune Thrombocytopenic Purpura Clinical Trial
Official title:
Predictive Value of the Initial Hemato-immunological Profile on the Evolution of Immunological Thrombopenic Purpura of Children and Adults.
This study aims to determine the hemato-immunological parameters predictive of the evolution of a Immune thrombocytopenic purpura (ITP) towards chronicity, and to identify possible differences between the child and the adult.
Immune thrombocytopenic purpura (ITP) is a rare autoimmune thrombocytopenia whose incidence
is 2 to 5 cases / 100,000 inhabitants / year. The potentially serious haemorrhagic risk is
the major issue of management. A recent international consensus conference classifies PTI
according to the duration of thrombocytopenia: acute ITP (<3 months), persistent ITP (3-12
months) and chronic ITP (> 12 months) (Rodeghiero 2009). In the acute or persistent phase,
polyvalent immunoglobulins (IVIG) and / or corticosteroids are proposed. In the chronic
phase, splenectomy is a possible cure for 70% of patients. No predictor of treatment response
is known.
The pathophysiology of ITP is multifactorial: platelet phagocytosis, mediated by
autoantibody, macrophages of the reticuloendothelial system, and destruction in the spleen,
genetic background and / or environmental factor favoring the role of certain lymphocyte
subpopulations, cytotoxic or regulatory T, via their cytokine environment, abnormalities of
thrombopoiesis.
ITP affects children as well as adults, but the evolutionary profile is very different. In
children, ITP, which is often post-infectious, is acute in 80% of cases, whereas ITP in
adults has a chronic evolution in 80% of cases. The primary diagnostic and therapeutic
practices are similar. The reasons for these evolutionary differences are not known and
little studied.
Is the orientation of the hemato-immunological response observed during the first episode of
ITP different in children and adults? Do these differences explain the evolutionary
specificities of the two age groups? Are there hematologic parameters predictive of a
response to initial treatments?
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