{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T10:45:27Z","timestamp":1788777927355,"version":"build-2803163510"},"reference-count":25,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2025,7,16]],"date-time":"2025-07-16T00:00:00Z","timestamp":1752624000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: The assessment of platelet kinetics (APK) is recommended for patients with chronic idiopathic thrombocytopenic purpura (chITP). The aim of this study was to examine the importance of APK as a prognostic instrument in the selection of therapy in children with chITP. Methods: Retrospective, observational research, which included chITP children who were treated and subjected to APK in Serbia for 25 years (total number was 152). Results: In the acute phase of the disease, 15% of patients had life-threatening bleeding, 15% were asymptomatic, and there were no cases of fatal bleeding. Mean platelet life was 0.89 \u00b1 0.47 days. A total of 45% of patients had normal platelet production, and 35% had very low production. Among the patients, 55% exhibited splenic platelet sequestration, 35% had mixed sequestration, and 10% showed hepatic platelet sequestration. Platelet lifespan and production indices were less reliable parameters, due to numerous contradictory results, especially when compared with the location of platelet sequestration. Distribution of bleeding and therapy-resistant patients was dominant with mixed sequestration. Good therapy responders had dominant splenic sequestration. In the chronic phase of the disease, initial therapy was sufficient for 40\u201345% of patients, while another 25% required second-line therapy, regardless of platelet sequestration location. A total of 25% percent of patients had undergone splenectomy, and all of them were in stable remission. The remaining 10%, which represented the most severe cases, required all available therapies, had equally mixed and liver sequestration, and splenectomy showed no effect. Conclusions: APK may be a determining factor for the selection of splenectomy as a therapeutic option in case of predominantly splenic sequestration. Although the platelet production index has been explored in several studies, its clinical relevance remains controversial. In our findings, it did not contribute to therapeutic decision-making and may even lead to misinterpretation. The factors distinguishing the minority of bleeding and therapy-resistant patients with similar laboratory profiles remain unclear.<\/jats:p>","DOI":"10.3390\/diagnostics15141790","type":"journal-article","created":{"date-parts":[[2025,7,16]],"date-time":"2025-07-16T10:46:05Z","timestamp":1752662765000},"page":"1790","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The Prognostic Value of Platelet Kinetics Assessment in Pediatric Chronic Idiopathic Thrombocytopenic Purpura"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0822-3554","authenticated-orcid":false,"given":"Nebojsa","family":"Igrutinovic","sequence":"first","affiliation":[{"name":"University Clinical Center Kragujevac, Zmaj Jovina 30, 34000 Kragujevac, Serbia"},{"name":"Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovi\u0107a 69, 34000 Kragujevac, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7013-8484","authenticated-orcid":false,"given":"Jelena","family":"Pantovic","sequence":"additional","affiliation":[{"name":"Center for Nuclear Medicine, University Clinical Center of Serbia, Vi\u0161egradska 26, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-3179-6043","authenticated-orcid":false,"given":"Bojana","family":"Markovic","sequence":"additional","affiliation":[{"name":"University Clinical Center Kragujevac, Zmaj Jovina 30, 34000 Kragujevac, Serbia"},{"name":"Department of Pediatrics, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovi\u0107a 69, 34000 Kragujevac, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marija","family":"Medovic","sequence":"additional","affiliation":[{"name":"University Clinical Center Kragujevac, Zmaj Jovina 30, 34000 Kragujevac, Serbia"},{"name":"Department of Dermatovenereology, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovi\u0107a 69, 34000 Kragujevac, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milica","family":"Cekerevac","sequence":"additional","affiliation":[{"name":"University Clinical Center Kragujevac, Zmaj Jovina 30, 34000 Kragujevac, Serbia"},{"name":"Department of Pediatrics, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovi\u0107a 69, 34000 Kragujevac, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0248-3590","authenticated-orcid":false,"given":"Vladimir","family":"Markovic","sequence":"additional","affiliation":[{"name":"University Clinical Center Kragujevac, Zmaj Jovina 30, 34000 Kragujevac, Serbia"},{"name":"Department of Microbiology, Immunology and Fundamentals of Oncology, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovi\u0107a 69, 34000 Kragujevac, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Strahinja","family":"Odalovic","sequence":"additional","affiliation":[{"name":"Center for Nuclear Medicine, University Clinical Center of Serbia, Vi\u0161egradska 26, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine, University of Belgrade, Dr. Subotica Starijeg 8, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7921-8157","authenticated-orcid":false,"given":"Sanja","family":"Knezevic","sequence":"additional","affiliation":[{"name":"University Clinical Center Kragujevac, Zmaj Jovina 30, 34000 Kragujevac, Serbia"},{"name":"Department of Pediatrics, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovi\u0107a 69, 34000 Kragujevac, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Vujic","sequence":"additional","affiliation":[{"name":"University Clinical Center Kragujevac, Zmaj Jovina 30, 34000 Kragujevac, Serbia"},{"name":"Department of Pediatrics, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovi\u0107a 69, 34000 Kragujevac, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isidora","family":"Mihajlovic","sequence":"additional","affiliation":[{"name":"University Clinical Center Kragujevac, Zmaj Jovina 30, 34000 Kragujevac, Serbia"},{"name":"Department of Pediatrics, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovi\u0107a 69, 34000 Kragujevac, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nevena","family":"Stojadinovic","sequence":"additional","affiliation":[{"name":"University Clinical Center Kragujevac, Zmaj Jovina 30, 34000 Kragujevac, Serbia"},{"name":"Department of Communication Skills, Ethics and Psychology, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovi\u0107a 69, 34000 Kragujevac, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dragan","family":"Knezevic","sequence":"additional","affiliation":[{"name":"University Clinical Center Kragujevac, Zmaj Jovina 30, 34000 Kragujevac, Serbia"},{"name":"Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovi\u0107a 69, 34000 Kragujevac, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nina","family":"Urakovic","sequence":"additional","affiliation":[{"name":"University Clinical Center Kragujevac, Zmaj Jovina 30, 34000 Kragujevac, Serbia"},{"name":"Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovi\u0107a 69, 34000 Kragujevac, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivana","family":"Andrejevic","sequence":"additional","affiliation":[{"name":"University Clinical Center Kragujevac, Zmaj Jovina 30, 34000 Kragujevac, Serbia"},{"name":"Department of Pathophysiology, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovi\u0107a 69, 34000 Kragujevac, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gordana J.","family":"Ristic","sequence":"additional","affiliation":[{"name":"University Clinical Center Kragujevac, Zmaj Jovina 30, 34000 Kragujevac, Serbia"},{"name":"Department of Dermatovenereology, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovi\u0107a 69, 34000 Kragujevac, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vladimir","family":"Slavkovic","sequence":"additional","affiliation":[{"name":"University Clinical Center Kragujevac, Zmaj Jovina 30, 34000 Kragujevac, Serbia"},{"name":"Department of Dermatovenereology, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovi\u0107a 69, 34000 Kragujevac, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristina","family":"Andric","sequence":"additional","affiliation":[{"name":"University Clinical Center Kragujevac, Zmaj Jovina 30, 34000 Kragujevac, Serbia"},{"name":"Department of Dermatovenereology, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovi\u0107a 69, 34000 Kragujevac, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rasa","family":"Medovic","sequence":"additional","affiliation":[{"name":"University Clinical Center Kragujevac, Zmaj Jovina 30, 34000 Kragujevac, Serbia"},{"name":"Department of Pediatrics, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovi\u0107a 69, 34000 Kragujevac, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"664","DOI":"10.3949\/ccjm.88a.20201","article-title":"Updated guidelines for immune thrombocytopenic purpura: Expanded management options","volume":"88","author":"DeSouza","year":"2021","journal-title":"Clevel. Clin. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"3829","DOI":"10.1182\/bloodadvances.2019000966","article-title":"American Society of Hematology 2019 guidelines for immune thrombocytopenia","volume":"3","author":"Neunert","year":"2019","journal-title":"Blood Adv."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1097\/00043426-200411000-00007","article-title":"Long-term outcome of chronic idiopathic thrombocytopenic purpura in children","volume":"26","author":"Jayabose","year":"2004","journal-title":"J. Pediatr. Hematol. Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1080\/13696998.2019.1669329","article-title":"Primary immune thrombocytopenia in US clinical practice: Incidence and healthcare burden in first 12 months following diagnosis","volume":"23","author":"Weycker","year":"2020","journal-title":"J. Med. Econ."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1210","DOI":"10.1111\/jth.14762","article-title":"Anti-platelet antibodies in childhood immune thrombocytopenia: Prevalence and prognostic implications","volume":"18","author":"Schmidt","year":"2020","journal-title":"J. Thromb. Haemost."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e606","DOI":"10.1097\/MPH.0000000000001836","article-title":"Latent and overt polyautoimmunity in children and adolescents with immune thrombocytopenia","volume":"42","author":"Kamioka","year":"2020","journal-title":"J. Pediatr. Hematol. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1080\/10245332.2017.1422316","article-title":"Thrombopoietin and its receptor expression in pediatric patients with chronic immune thrombocytopenia","volume":"23","author":"Li","year":"2018","journal-title":"Hematology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1111\/ejh.13547","article-title":"Histology of the spleen in immune thrombocytopenia: Clinical-pathological characterization and prognostic implications","volume":"106","author":"Pizzi","year":"2021","journal-title":"Eur. J. Haematol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2507","DOI":"10.3324\/haematol.2020.261099","article-title":"Splenectomy for immune thrombocytopenia: The evolution and preservation of treatment","volume":"105","author":"Remiker","year":"2020","journal-title":"Haematologica"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"931","DOI":"10.1111\/bjh.16448","article-title":"Second-line treatment trends and long-term outcomes of 392 children with chronic immune thrombocytopenic purpura: The French experience over the past 25 years","volume":"189","author":"Ducassou","year":"2020","journal-title":"Br. J. Haematol."},{"key":"ref_11","first-page":"119","article-title":"Prediction of the splenectomy efficacy in chronic immune thrombocytopenic purpura","volume":"48","year":"2005","journal-title":"Glas. Srp. Akad. Nauka Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.1002\/ajh.23823","article-title":"The choice of second-line therapy in steroid-resistant immune thrombocytopenia: Role of platelet kinetics in a single-centre long-term study","volume":"89","author":"Palandri","year":"2014","journal-title":"Am. J. Hematol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"573","DOI":"10.3109\/09537104.2014.959915","article-title":"Does the site of platelet sequestration predict the response to splenectomy in adult patients with immune thrombocytopenic purpura?","volume":"26","author":"Navez","year":"2015","journal-title":"Platelets"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1111\/j.1365-2141.2010.08377.x","article-title":"Autologous 111 In-labelled platelet sequestration studies in patients with primary immune thrombocytopenia (ITP) prior to splenectomy: A report from the United Kingdom ITP Registry","volume":"151","author":"Sarpatwari","year":"2010","journal-title":"Br. J. Haematol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"975","DOI":"10.1007\/s00277-008-0537-1","article-title":"Platelet production rate predicts the response to prednisone therapy in patients with idiopathic thrombocytopenic purpura","volume":"87","author":"Houwerzijl","year":"2008","journal-title":"Ann. Hematol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1159\/000335553","article-title":"Platelet kinetics in idiopathic thrombocytopenic purpura patients treated with thrombopoietin receptor agonists","volume":"39","author":"Meyer","year":"2012","journal-title":"Transfus. Med. Hemother."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2596","DOI":"10.1182\/blood-2012-07-442392","article-title":"Standardization of bleeding assessment in immune thrombocytopenia: Report from the International Working Group","volume":"121","author":"Rodeghiero","year":"2013","journal-title":"Blood"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1067\/mpd.2002.128547","article-title":"Grading of hemorrhage in children with idiopathic thrombocytopenic purpura","volume":"141","author":"Buchanan","year":"2002","journal-title":"J. Pediatr."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e26598","DOI":"10.1002\/pbc.26598","article-title":"Clinical outcome of childhood chronic immune thrombocytopenia: A 38-year experience from a single tertiary center in Thailand","volume":"64","author":"Chotsampancharoen","year":"2017","journal-title":"Pediatr. Blood Cancer"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1055\/a-2247-4209","article-title":"Update on the Use of Thrombopoietin-Receptor Agonists in Pediatrics","volume":"44","author":"Gebetsberger","year":"2024","journal-title":"Hamostaseologie"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2513","DOI":"10.1007\/s00277-020-04257-2","article-title":"Treatment outcomes and chronicity predictors for primary immune thrombocytopenia: 10-year data from an academic center","volume":"99","year":"2020","journal-title":"Ann. Hematol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1111\/ijlh.13536","article-title":"Cytomorphology of normal, reactive, dysmorphic, and dysplastic megakaryocytes in bone marrow aspirates","volume":"43","author":"Zini","year":"2021","journal-title":"Int. J. Lab. Hematol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1097\/MBC.0000000000000144","article-title":"B-cell-activating factor, a proliferation inducing ligand and co-stimulatory molecules in the pathogenesis of immune thrombocytopenia in childhood","volume":"27","author":"Karapnar","year":"2016","journal-title":"Blood Coagul. Fibrinolysis"},{"key":"ref_24","first-page":"202","article-title":"Correlation between clinical outcome of 115 patients with idiopathic thrombocytopenic purpura and megakaryocyte counts in bone marrow biopsy","volume":"19","author":"Zhou","year":"2011","journal-title":"Zhongguo Shi Yan Xue Ye Xue Za Zhi"},{"key":"ref_25","first-page":"72","article-title":"Efficacy and safety of splenectomy in immune thrombocytopenic purpura: Long-term results of 402 cases","volume":"90","author":"Vianelli","year":"2005","journal-title":"Haematologica"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/14\/1790\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:10:28Z","timestamp":1760033428000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/14\/1790"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,16]]},"references-count":25,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["diagnostics15141790"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15141790","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,16]]}}}