Published online January 2, 2008
PEDIATRICS Vol. 121 Supplement January 2008, pp. S122-S123 (doi:10.1542/peds.2007-2022ZZZ)
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HEMATOLOGY AND ONCOLOGY


RECURRENT IDIOPATHIC THROMBOCYTOPENIC PURPURA IN CHILDHOOD

Maria Vranou, Helen Pergantou, Helen Platokouki, Dimitris Kousiafes, Maria Avgeri and Sophia Aronis

Hemostasis Unit, Agia Sophia Children's Hospital, Athens, Greece

ABSTRACT

INTRODUCTION: Idiopathic thrombocytopenic purpura (ITP) is usually a benign disease that remits within weeks to years. The literature on recurrent ITP (rITP) is limited.

OBJECTIVE: The aim of this study was to retrospectively review patients with rITP who were followed up during the period of 1975–2004.

METHODS: We reviewed the outcome of 790 children with rITP

RESULTS: Among 790 children with ITP, 47 (5.2%) presented with >1 episode of thrombocytopenia. The median age of the children at onset of the disease was 55.9 ± 35.3 months and at final remission was 94.4 ± 58.9 months. The majority of patients (76.6%) had 1 recurrence, whereas the rest of them had >1 recurrence (up to 4); the total number of recurrences was 63. The interval between 2 episodes was <6 months in 25% of the episodes, 6 to 12 months in 29%, 12 to 24 months in 24%, 24 to 36 months in 8%, and >3 years in 14%. Almost half the patients demonstrated bleeding manifestations at diagnosis, whereas only a minority (5) showed bleeding symptoms during the first recurrence. Hemorrhages occurred at times of severe thrombocytopenia and were, in general, mild; however, 1 patient suffered intracranial hemorrhage. Of the episodes, 28.6% necessitated hospitalization and 17.5% required therapeutic intervention with corticosteroids or/and intravenous immunoglobulin. The long-term outcome of all patients was excellent, and none of them needed splenectomy.

CONCLUSIONS: rITP occurs mostly in young children, has a good outcome after >1 to 5 episodes, and a median age that ranges from months to years. The course is more often benign; however, life-threatening hemorrhage may occur in a severely thrombocytopenic patient.

Submitted by Maria Vranou