{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T02:16:51Z","timestamp":1792808211281,"version":"4.5.0"},"reference-count":38,"publisher":"American Society of Hematology","issue":"6","content-domain":{"domain":["ashpublications.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2021,3,23]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Primary immune thrombocytopenia (ITP) in children is a diagnosis of exclusion, but cases of secondary ITP and nonimmune thrombocytopenia (non-IT) are generally difficult to recognize in a timely fashion. We describe a pediatric population with a revised diagnosis of secondary ITP or non-IT within 24 months of follow-up. Data were extracted from the Pediatric and Adult Registry on Chronic ITP, an international multicenter registry collecting data prospectively in patients with newly diagnosed primary ITP. Between 2004 and 2019, a total of 3974 children aged 3 months to 16 years were included. Secondary ITP and non-IT were reported in 113 patients (63 female subjects). Infectious (n = 53) and autoimmune (n = 42) diseases were identified as the main causes, with median ages at diagnosis of 3.2 years (interquartile range: 1.2; 6.7 years) and 12.4 years (interquartile range: 7.6; 13.7 years), respectively. Other causes included malignancies, aplastic anemia, immunodeficiency, and drug use. Patients with malignancy and aplastic anemia had significantly higher initial platelet counts (37 and 52 \u00d7 109\/L) than did those with infection or autoimmune diseases (12 and 13 \u00d7 109\/L). Characteristics of patients with secondary ITP due to infection were similar to those of children with primary ITP at first presentation, indicating similar mechanisms. Significant differences were found for age, sex, comorbidities, initial bleeding, sustained need for treatment, and disease persistence for the remaining noninfectious group compared with primary ITP. Based on our findings, we propose a diagnostic algorithm that may serve as a basis for further discussion and prospective trials.<\/jats:p>","DOI":"10.1182\/bloodadvances.2020003004","type":"journal-article","created":{"date-parts":[[2021,3,12]],"date-time":"2021-03-12T11:34:55Z","timestamp":1615548895000},"page":"1617-1626","update-policy":"https:\/\/doi.org\/10.1182\/blood.2019cm0000","source":"Crossref","is-referenced-by-count":26,"title":["Misdiagnosed thrombocytopenia in children and adolescents: analysis of the Pediatric and Adult Registry on Chronic ITP"],"prefix":"10.1182","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9459-8709","authenticated-orcid":false,"given":"Alexandra","family":"Schifferli","sequence":"first","affiliation":[{"name":"Department of Hematology\/Oncology, University Children\u2019s Hospital Basel, Basel, Switzerland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Heiri","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Basel, Basel, Switzerland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Imbach","sequence":"additional","affiliation":[{"name":"Department of Hematology\/Oncology, University Children\u2019s Hospital Basel, Basel, Switzerland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susanne","family":"Holzhauer","sequence":"additional","affiliation":[{"name":"Department of Pediatric Hematology and Oncology, Charit\u00e9 University Medicine, Berlin, Germany;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0981-8661","authenticated-orcid":false,"given":"Markus G.","family":"Seidel","sequence":"additional","affiliation":[{"name":"Research Unit for Pediatric Hematology and Immunology, Division of Pediatric Hemato-\/Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1109-0879","authenticated-orcid":false,"given":"Diane","family":"Nugent","sequence":"additional","affiliation":[{"name":"Children's Hospital of Orange County, University of California Irvine, Irvine, CA; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Michel","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, National Reference Center for Adult Immune Cytopenias, Henri Mondor University Hospital, Assistance Publique\u2013Hopitaux de Paris, Universit\u00e9 Paris-Est Cr\u00e9teil, Cr\u00e9teil, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7387-7028","authenticated-orcid":false,"given":"Thomas","family":"K\u00fchne","sequence":"additional","affiliation":[{"name":"Department of Hematology\/Oncology, University Children\u2019s Hospital Basel, Basel, Switzerland;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"234","published-online":{"date-parts":[[2021,3,12]]},"reference":[{"issue":"11","key":"2021031815154391900_B1","doi-asserted-by":"crossref","first-page":"2386","DOI":"10.1182\/blood-2008-07-162503","article-title":"Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working 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