RESUMO
OBJECTIVE: To explore the clinical utility of measuring platelet-associated immunoglobulin (PAIG) at the time of diagnosis in children with immune thrombocytopenia (ITP). METHODS: PAIG was measured by flow cytometry using fluorescent murine anti-IgG and anti-IgM. In a cohort of 88 children with ITP, the assay was performed within 15 days of diagnosis and before any treatment in 68 cases. We reviewed the results and examined the relation of isotype profile and degree of elevation to clinical manifestations and course of disease. RESULTS: PAIG was elevated in 74%, with raised IgM being more frequent than IgG (63% vs. 44%, P = 0.04) and with isotype profile depending on symptom onset. Platelet counts at presentation were similar in all subgroups, but mucosal bleeding was less frequent in PAIG-negative patients compared to the positive groups (5.5% vs. 34%, P = 0.03). Duration of thrombocytopenia was similar in negative and positive cases, but during follow-up, significant bleeding events occurred less frequently in PAIG-negative patients (0% vs. 14%, P = 0.18). CONCLUSION: Approximately one-quarter of children are PAIG-negative, and these children have milder bleeding tendency at diagnosis and lower morbidity during follow-up. Raised PAIG possibly may cause some degree of platelet dysfunction.
Assuntos
Plaquetas/patologia , Hemorragia/diagnóstico , Imunoglobulina G/biossíntese , Imunoglobulina M/biossíntese , Púrpura Trombocitopênica Idiopática/diagnóstico , Adolescente , Plaquetas/imunologia , Criança , Pré-Escolar , Feminino , Citometria de Fluxo , Hemorragia/complicações , Hemorragia/imunologia , Hemorragia/patologia , Humanos , Isotipos de Imunoglobulinas , Lactente , Recém-Nascido , Masculino , Púrpura Trombocitopênica Idiopática/complicações , Púrpura Trombocitopênica Idiopática/imunologia , Púrpura Trombocitopênica Idiopática/patologiaRESUMO
During the COVID-19 pandemic, telemedicine and virtual consultations have been rapidly implemented in paediatrics all over the world. Previous and current studies have shown satisfaction with telemedicine, especially from a parental perspective. The largest barrier for implementation is technology. Some studies have found telemedicine equal to in-person visits. Only few studies have measured clinical outcomes, and the perspective of the child and adolescents as well as healthcare personal is rarely examined. There is a need of developing guidelines and education in paediatric telemedicine, as argued in this review.