Egyptian Pediatric Guidelines for the Management of Children with Isolated Thrombocytopenia Using the Adapted ADAPTE Methodology—A Limited-Resource Country Perspective
Galila Mokhtar,
Ashraf Abdelbaky,
Amira Adly,
Dina Ezzat,
Gehan Abdel Hakeem,
Hoda Hassab,
Ilham Youssry,
Iman Ragab,
Laila M. Sherief,
Marwa Zakaria,
Mervat Hesham,
Niveen Salama,
Nouran Salah,
Rasha A. A. Afifi,
Rasha El-Ashry,
Sara Makkeyah,
Sonia Adolf,
Yasser S. Amer,
Tarek E. I. Omar,
James Bussel,
Eman Abd El Raouf,
Mervat Atfy,
Mohamed Ellaboudy,
Ivan Florez
Affiliations
Galila Mokhtar
Pediatric Hematology and Oncology Unit, Pediatric Department, Ain Shams University, Cairo 11566, Egypt
Ashraf Abdelbaky
Pediatric Department, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt
Amira Adly
Pediatric Hematology and Oncology Unit, Pediatric Department, Ain Shams University, Cairo 11566, Egypt
Dina Ezzat
Pediatric Hematology Unit, Pediatric Department, Beni-Suef University, Beni-Suef 62521, Egypt
Gehan Abdel Hakeem
Pediatric Hematology and Oncology Unit, Pediatric Department, Minia University, Minia 61519, Egypt
Hoda Hassab
Pediatric Hematology and Oncology Unit, Pediatric Department, Faculty of Medicine, Alexandria University, Alexandria 21526, Egypt
Ilham Youssry
Pediatric Hematology and Bone Marrow Transplantation Unit, Pediatric Department, Cairo University, Giza 12613, Egypt
Iman Ragab
Pediatric Hematology and Oncology Unit, Pediatric Department, Ain Shams University, Cairo 11566, Egypt
Laila M. Sherief
Pediatric Hematology and Oncology Unit, Pediatric Department, Zagazig University, Zagazig 44519, Egypt
Marwa Zakaria
Pediatric Hematology and Oncology Unit, Pediatric Department, Zagazig University, Zagazig 44519, Egypt
Mervat Hesham
Pediatric Hematology and Oncology Unit, Pediatric Department, Zagazig University, Zagazig 44519, Egypt
Niveen Salama
Pediatric Hematology and Bone Marrow Transplantation Unit, Pediatric Department, Cairo University, Giza 12613, Egypt
Nouran Salah
Pediatric Department, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt
Rasha A. A. Afifi
Pediatric Hematology and Bone Marrow Transplantation Unit, Pediatric Department, Cairo University, Giza 12613, Egypt
Rasha El-Ashry
Pediatric Hematology and Oncology Unit, Pediatric Department, Mansoura University, Mansoura 35516, Egypt
Sara Makkeyah
Pediatric Hematology and Oncology Unit, Pediatric Department, Ain Shams University, Cairo 11566, Egypt
Sonia Adolf
Pediatric, Hematology Department, Institute of Medical Research and Clinical Studies, National Research Center, Giza 1770, Egypt
Yasser S. Amer
Pediatrics Department, Quality Management Department, King Saud University Medical City, Riyadh 11451, Saudi Arabia
Tarek E. I. Omar
Pediatrics Department, Faculty of Medicine, Alexandria University, Alexandria 21526, Egypt
James Bussel
Pediatrics Department, Well Cornell Medical College, New York, NY 10065, USA
Eman Abd El Raouf
Pediatric Hematology and Bone Marrow Transplantation Unit, Pediatric Department, Cairo University, Giza 12613, Egypt
Mervat Atfy
Pediatric Hematology and Oncology Unit, Pediatric Department, Zagazig University, Zagazig 44519, Egypt
Mohamed Ellaboudy
Pediatric Hematology and Oncology Unit, Pediatric Department, Ain Shams University, Cairo 11566, Egypt
Ivan Florez
Department of Pediatrics, University of Antioquia, Medellin 050010, Colombia
Background: Thrombocytopenia is a prevalent presentation in childhood with a broad spectrum of etiologies, associated findings, and clinical outcomes. Establishing the cause of thrombocytopenia and its proper management have obvious clinical repercussions but may be challenging. This article provides an adaptation of the high-quality Clinical Practice Guidelines (CPGs) of pediatric thrombocytopenia management to suit Egypt’s health care context. Methods: The Adapted ADAPTE methodology was used to identify the high-quality CPGs published between 2010 and 2020. An expert panel screened, assessed and reviewed the CPGs and formulated the adapted consensus recommendations based on the best available evidence. Discussion: The final CPG document provides consensus recommendations and implementation tools on the management of isolated thrombocytopenia in children and adolescents in Egypt. There is a scarcity of evidence to support recommendations for various management protocols. In general, complete clinical assessment, full blood count, and expert analysis of the peripheral blood smear are indicated at initial diagnosis to confirm a bleeding disorder, exclude secondary causes of thrombocytopenia and choose the type of work up required. The International Society of Hemostasis and thrombosis–Bleeding assessment tool (ISTH-SCC BAT) could be used for initial screening of bleeding manifestations. The diagnosis of immune thrombocytopenic purpura (ITP) is based principally on the exclusion of other causes of isolated thrombocytopenia. Future research should report the outcome of this adapted guideline and include cost-analysis evaluations.
