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  1. Fulltext Helicobacter pylori infection in chronic immune thrombocytopenic purpura patients in Malaysia
    Gan GG, Norfaizal AL, Bee PC, Chin EF, Habibah AH, Goh KL
    Med J Malaysia, 2013 Jun;68(3):231-3.
    PMID: 23749012 MyJurnal
    Helicobacter Pylori has been implicated with a possible link to immune thrombocytopenia purpura (ITP) and studies have shown contradicting results in platelet recovery after eradication of H pylori infection.
    Matched MeSH terms: Purpura, Thrombocytopenic, Idiopathic*
  2. Primary versus secondary immune thrombocytopenia in adults; a comparative analysis of clinical and laboratory attributes in newly diagnosed patients in Southern Pakistan
    Sultan S, Ahmed SI, Murad S, Irfan SM
    Med J Malaysia, 2016 10;71(5):269-274.
    PMID: 28064294
    BACKGROUND: Immune thrombocytopenic purpura (ITP) is a hemorrhagic diathesis, characterized by platelets destruction alongside impaired production. Patients from Asian regions often exhibit distinctive characteristics in comparison to the western patients. We accomplished this study to evaluate the prevalence of primary versus secondary ITP along with the comparative analysis between them. The secondary objective was to determine the etiological spectrum of secondary ITP.

    METHODS: We illustrate the results of a large cohort of newly diagnosed adults ITP from southern Pakistan. The study extended from January 2009-December 2013. Complete blood counts, HbsAg, Anti-HCV, ANA, stool for Helicobacterpylori were done on all. HIV, TSH, anti-dsDNA, RA factor, APLA and direct coombs test were evaluated in cases where indicated.

    RESULTS: A total of 417 patients were included with a mean age of 40.95±14.82 years. Primarily disease was observed in the 3rd decade of life. Male to female ratio was 1:1.5. Mean platelets count was 46.21±27.45x109/l. At diagnosis 43.16% (n=180) patients had hemorrhagic manifestations whilst 56.8% (n=237) were asymptomatic. None of the patient presented with visceral, retropharyngeal or intracranial bleed. The prevalence of secondary ITP was substantially higher (64.8%) as compared to primary ITP (35.2%). Secondary ITP was predominantly seen in HCV reactive patients (24.4%) followed by helicobacter-pylori infection (11%). Nevertheless 16.4% patients had underlying autoimmune disorders. Providentially no study subject was found to be HIV reactive.

    CONCLUSIONS: Our study revealed predominance of secondary ITP. However bleeding manifestations and degree of thrombocytopenia were high in primary-ITP. Infectious etiology followed by autoimmune disorders is mainly implicated for secondary ITP in our setting.

    Matched MeSH terms: Purpura, Thrombocytopenic, Idiopathic/complications; Purpura, Thrombocytopenic, Idiopathic/diagnosis*; Purpura, Thrombocytopenic, Idiopathic/etiology
  3. A four-point clinical criteria distinguishes immune thrombocytopenia from acute lymphoblastic leukaemia
    Lum SH, How SJ, Ariffin H, Krishnan S
    Med J Malaysia, 2016 02;71(1):28-9.
    PMID: 27130741
    Immune thrombocytopenia is the most common diagnosis of isolated thrombocytopenia. The dilemma encountered by paediatricians is missing diagnosis of acute leukaemia in children with isolated thrombocytopenia. We demonstrated childhood ITP could be diagnosed using a four point clinical criteria without missing a diagnosis of acute leukaemia. Hence, bone marrow examination is not necessary in children with typical features compatible with ITP prior to steroid therapy. This can encourage paediatricians to choose steroid therapy, which is cheaper and non-blood product, as first line platelet elevating therapy in children with significant haemorrhage.
    Matched MeSH terms: Purpura, Thrombocytopenic, Idiopathic/diagnosis*
  4. Fulltext A rare case of autoimmune hepatitis overlapping with autoimmune haemolytic anaemia and immune thrombocytopenic purpura in a male patient
    Palaniappan S, Ramanaidu S
    Med J Malaysia, 2012 Jun;67(3):326-8.
    PMID: 23082427 MyJurnal
    Matched MeSH terms: Purpura, Thrombocytopenic, Idiopathic/complications*; Purpura, Thrombocytopenic, Idiopathic/diagnosis; Purpura, Thrombocytopenic, Idiopathic/drug therapy
  5. Persistent thrombocytopenia following dengue fever: What should we do?
    Boo YL, Lim SY, P'ng HS, Liam C, Huan NC
    Malays Fam Physician, 2019;14(3):71-73.
    PMID: 32175045
    Thrombocytopenia is a common laboratory finding in dengue infection. However, it usually resolves as the patient recovers from the infection. Persistent thrombocytopenia following dengue infection requires further investigation. Here, we present a case of immune thrombocytopenic purpura (ITP) following dengue infection complicated by intracranial bleeding.
    Matched MeSH terms: Purpura, Thrombocytopenic, Idiopathic
  6. Fulltext Corticosteroid-responsive prolonged thrombocytopenia following dengue haemorrhagic fever
    Leong KW, Srinivas P
    Med J Malaysia, 1993 Sep;48(3):369-72.
    PMID: 8183156
    A case of prolonged thrombocytopenia following dengue haemorrhagic fever in a 15 year old boy is reported. The mechanism was presumed to be immunological and he responded dramatically to oral prednisolone.
    Matched MeSH terms: Purpura, Thrombocytopenic, Idiopathic/drug therapy; Purpura, Thrombocytopenic, Idiopathic/etiology*
  7. User-driven health care - answering multidimensional information needs in individual patients utilizing post-EBM approaches: a conceptual model
    Biswas R, Martin CM, Sturmberg J, Shanker R, Umakanth S, Shanker S, et al.
    J Eval Clin Pract, 2008 Oct;14(5):742-9.
    PMID: 19018905 DOI: 10.1111/j.1365-2753.2008.00998.x
    Evidence based on average patient data, which occupies most of our present day information databases, does not fulfil the needs of individual patient-centred health care. In spite of the unprecedented expansion in medical information we still do not have the types of information required to allow us to tailor optimal care for a given individual patient. As our current information is chiefly provided in disconnected silos, we need an information system that can seamlessly integrate different types of information to meet diverse user group needs. Groups of certain individual medical learners namely patients, medical students and health professionals share the patient's need to increasingly interact with and seek knowledge and solutions offered by others (individual medical learners) who have the lived experiences that they would benefit to access and learn from. A web-based user-driven learning solution may be a stepping-stone to address the present problem of information oversupply in medicine that mostly remains underutilized, as it doesn't meet the needs of the individual patient and health professional user. The key to its success would be to relax central control and make local trust and strategic health workers feel more engaged in the project such that it is truly user-driven.
    Matched MeSH terms: Purpura, Thrombocytopenic, Idiopathic/diagnosis; Purpura, Thrombocytopenic, Idiopathic/psychology; Purpura, Thrombocytopenic, Idiopathic/therapy
  8. Fulltext Spontaneous intracranial haemorrhage in children with chronic immune thrombocytopenic purpura
    Muda Z, Ibrahim H, Abdulrahman EJ, Mahfuzah M, Othman IS, Asohan T, et al.
    Med J Malaysia, 2014 Dec;69(6):288-90.
    PMID: 25934964 MyJurnal
    Spontaneous intracranial haemorrhage (ICH) is a rare complication of chronic immune thrombocytopenic purpura (ITP) in children. We report four patients with cITP who developed ICH. The latency between onset of ITP and ICH varied from 1-8 years. All our patients were profoundly thrombocytopenic (platelet count of <10 x 109/l) at the time of their intracranial bleed. The presenting features and management are discussed. All patients survived, three had complete neurological recovery while one had a minimal residual neurological deficit.
    Matched MeSH terms: Purpura, Thrombocytopenic, Idiopathic
  9. Extragastrointestinal manifestations of Helicobacter pylori infection: facts or myth? A critical review
    Tan HJ, Goh KL
    J Dig Dis, 2012 Jul;13(7):342-9.
    PMID: 22713083 DOI: 10.1111/j.1751-2980.2012.00599.x
    Helicobacter pylori (H. pylori) infection is reported to be associated with many extragastrointestinal manifestations, such as hematological diseases [idiopathic thrombocytopenic purpura (ITP) and unexplained iron deficiency anemia (IDA)], cardiovascular diseases (ischemic heart diseases), neurological disorders (stroke, Parkinson's disease, Alzheimer's disease), obesity and skin disorders. Among these, the best evidence so far is in ITP and unexplained IDA, with high-quality studies showing the improvement of IDA and ITP after H. pylori eradication. The evidence of its association with coronary artery disease is weak and many of the results may be erroneous. The role of H. pylori infection in affecting serum leptin and ghrelin levels has attracted a lot of attention recently and available data to date have been conflicting. There have also been many uncontrolled, small sample studies suggesting an association between H. pylori infection and neurological disorders or chronic urticaria. However, more studies are required to clarify such proposed causal links.
    Matched MeSH terms: Purpura, Thrombocytopenic, Idiopathic/microbiology
  10. Fulltext Efficacy of helicobacter pylori eradication as an upfront treatment of secondary immune thrombocytopenia: an experience from Pakistan
    Sultan S, Irfan SM, Kaker J, Hasan M
    Med J Malaysia, 2016 04;71(2):53-6.
    PMID: 27326941
    BACKGROUND: The effect of Helicobacter-pylori eradication therapy on the platelet counts in patients with immune thrombocytopenia is still debatable. The aim of this study was to assess the response rates of standard triple eradication therapy in secondary immune thrombocytopenia with Helicobacter pylori infection.

    METHODS: From January 2012 to December 2013, 197 patients were diagnosed to have immune thrombocytopenia, out of which 22(11.1%) patients infected with Helicobacter- Pylorus were enrolled in this study. Helicobacter-Pylori infection was documented by Helicobacter-pylori stool antigen enzyme immunoassay method. All positive patients were put on triple eradication therapy. The responses rates to treatment were defined as per International Working Group on ITP.

    RESULTS: Mean age of patients was 43.18±12.5 years. There were 10(45.5%) males and 12 (54.5%) females. Of the 22 patients, 7(31.8%) exhibited a complete response (CR) to Hpylori eradication therapy; 10(45.4%) attained a response; and 5(22.7%) had no response. Mean base line platelet counts were 53.36±24.5x109/l, while platelet counts at 4 week following eradication was 80.86±51.0x109/l (P=0.003). The predictive factor of response following eradication therapy was baseline platelet counts. Virtually all responders had baseline platelet counts >30x109/l and all non-responders had <30x109/l of platelet counts.

    CONCLUSIONS: Though the prevalence of H-pylori is low, this study confirmed the efficacy of eradication in increasing the platelet counts in H-pylori positive patients with ITP. It is an important measure in short time, safe and very cost effective to achieve platelets increment. We endorse the routine detection and eradication treatment of H-pylori infective ITP patients.
    Matched MeSH terms: Purpura, Thrombocytopenic, Idiopathic/complications*
  11. A case of immune thrombocytopenic purpura with prolonged aPTT time: A clotter hidden in a bleeder?
    Lee MH, Khoo PJ, Gew LT, Ng CF
    Med J Malaysia, 2017 12;72(6):365-366.
    PMID: 29308775 MyJurnal
    We report the case of a 23-year-old woman who presented with prolonged menstruation and multiple bruises on the limbs and trunk. Investigations revealed severe thrombocytopenia and deranged coagulation profile with markedly prolonged activated partial thromboplastin time (aPTT). Lupus anticoagulant, anti-cardiolipin antibody and anti-beta-2-glycoprotein 1 antibody were positive. She was diagnosed with Immune Thrombocytopenic Purpura (ITP) with positive antiphospholipid antibody serology and given a course of intravenous methylprednisolone and tapering doses of oral prednisolone. She was steroid free and had no bleeding or thrombotic event over two years follow up.
    Matched MeSH terms: Purpura, Thrombocytopenic, Idiopathic/drug therapy*
  12. Fulltext Idiopathic thrombocytopenic purpura in childhood, Langerhans cell histiocytosis in adulthood: More than a chance association?
    Kuan YC, Nurain MN
    Med J Malaysia, 2017 02;72(1):50-52.
    PMID: 28255140 MyJurnal
    Described herein, a case of Langerhans cell histiocytosis (LCH) in an adult with Idiopathic Thrombocytopenic Purpura (ITP) diagnosed at age ten. She presented with cranial diabetes insipidus, later developed hypogonadotrophic hypogonadism and multiple cervical lympadenopathy from which histopathology of excisional biopsy confirmed LCH. Magnetic resonance imaging showed thickened pituitary stalk. Association of ITP and LCH is unknown but the question of LCH presenting as isolated thrombocytopenia in childhood only to be discovered in adulthood when there was pituitary and bone involvement remains. It reemphasizes the need for high index of suspicion and the challenges in diagnosing LCH at the outset.
    Matched MeSH terms: Purpura, Thrombocytopenic, Idiopathic
  13. Prolonged remission after splenectomy for refractory Evans syndrome--a case report and literature review
    Hamidah A, Thambidorai CR, Jamal R
    Southeast Asian J. Trop. Med. Public Health, 2005 May;36(3):762-4.
    PMID: 16124452
    We describe a patient with Evans syndrome (autoimmune hemolytic anemia and autoimmune thrombocytopenia) who was refractory to steroids and intravenous immunoglobulin. She responded to splenectomy and has remained in clinical remission for 3 years. In the majority of cases, splenectomy rarely induces a durable remission but it may be beneficial in a small group of patients, hence should be considered as alternative therapy in the management of these patients.
    Matched MeSH terms: Purpura, Thrombocytopenic, Idiopathic/therapy*
  14. Vaccine-induced immune thrombocytopaenia purpura in autologous haematopoietic stem cell transplantation
    Wan Jamaludin WF, Kok WH, Loong L, Palaniappan SK, Zakaria MZ, Ong TC, et al.
    Med J Malaysia, 2018 12;73(6):430-432.
    PMID: 30647224
    Immune Thrombocytopenia Purpura (ITP) secondary to vaccinations is rare, especially after autologous hematopoietic stem cell transplantation (HSCT). A 31-yearold female received autologous HSCT for relapsed Hodgkin Disease, with platelet engraftment at Day+14. One week after receiving second scheduled vaccinations, she developed severe thrombocytopenia (3x109/L) associated with pharyngeal hematoma. Bone marrow (BM) examinations were consistent with ITP, possibly secondary to Influenza vaccine. Platelet increment was poor despite high dose corticosteroids, intravenous immunoglobulin (IVIG), Danazol and Eltrombopag. A repeated BM biopsy was in agreement with ITP. Re-treatment with tapering doses of prednisolone resulted in stable platelet counts at 120x109/L a year later.
    Matched MeSH terms: Purpura, Thrombocytopenic, Idiopathic/etiology*
  15. Fulltext Spectrum of hematological disorders in children diagnosed by bone marrow aspiration/biopsy: a retrospective study in a tertiary care center
    Khan, Humayun Iqbal, Amir Rashid, Shabbir, A.S., Warriach, Israr B., Tariq, Rabia, Sarfraz, A., et al.
    Malaysian Journal of Paediatrics and Child Health, 2011;17(1):0-0.
    MyJurnal
    Objective: This study assessed the pattern of clinical course of hematological disorders in children diagnosed by bone marrow aspiration/biopsy in a tertiary care centre. Setting: The study was conducted at the Department of Pediatrics, Lahore General Hospital, Pakistan. Design: A retrospective descriptive study. Duration of study: Jan 2006 to Dec 2010. Methods: The clinical and laboratory data of 250 patients including complete history, physical examination, investigations and bone marrow examination reports were collected and then analyzed retrospectively. On the basis of these data, relative frequency of different hematological disorders was determined. Results: A total of 250 patients were selected during this study period where their bone marrow was sent for the investigations. Out of these cases, double deficiency anemia was the commonest diagnosis (22%) followed by aplastic anemia (13.6%), megaloblastic anemia (13.2%) and iron deficiency anemia (5.6%). For hematological malignancies, acute lymphoblastic leukemia (ALL) was observed in 27 cases (10.8%) followed by acute myeloid leukemia (AML) in 12 cases (4.8%), lymphoma in 8 cases (3.2%) and chronic myeloid leukemia (CML) in only two cases. Idiopathic thrombocytopenic purpura (ITP) was reported as frequent as 13.2% (33 cases). Conclusion: The pattern of non malignant hematological disorders in children diagnosed by bone marrow aspiration/biopsy was more common than malignant conditions. Double deficiency anemia was the commonest non malignant condition followed by aplastic anemia, idiopathic thrombocytopenic purpura and megaloblastic anemia. ALL was the most common presentation of the hematological malignancy.
    Matched MeSH terms: Purpura, Thrombocytopenic, Idiopathic
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