title: Major hemorrhage in children with idiopathic thrombocytopenic purpura: immediate response to therapy and long-term outcome.
abstract: OBJECTIVE
  We retrospectively characterized children with idiopathic thrombocytopenic purpura (ITP) who had major hemorrhage to determine response to therapy and long-term outcome.
  
  
  METHODS
  We reviewed the medical records of 332 children with ITP diagnosed at our center during the last 10 years for occurrence of major hemorrhage, defined as (1) intracranial hemorrhage, (2) epistaxis requiring cautery or nasal packing, (3) gross hematuria, or (4) other bleeding causing a decline in hemoglobin concentration.
  
  
  RESULTS
  Of 332 patients with ITP, 58 (17%) had 68 episodes of major hemorrhage; 56 of these episodes were treated with corticosteroids, intravenous immunoglobulin, or both. The platelet count rose to > or =20,000/mm3 within 24 hours after presentation after only 18% of evaluated events, and 28% of patients with major hemorrhage still had a platelet count <20,000/mm3 after 7 days. Twenty-seven of 49 patients available for evaluation had resolution of ITP within 6 months, 21 had chronic ITP, and 1 died of sepsis.
  
  
  CONCLUSIONS
  We observed that 17% of children with ITP had major hemorrhage. Only a minority of these patients had an immediate rise in platelet count after receiving intravenous immunoglobulin, corticosteroid treatment, or both. Prospective studies of childhood ITP focusing on short-term outcome variables in addition to platelet count should be performed to better define optimal treatment for each affected child.
authors.affiliation: Department of Pediatrics, The University of Texas Southwestern Medical Center at Dallas and the Center for Cancer and Blood Disorders, 75235-9063, USA.
authors.forename: D
authors.initials: D
authors.lastname: Medeiros
authors.forename: G R
authors.initials: GR
authors.lastname: Buchanan
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D002423:Cause of Death; D002425:Cautery; D002543:Cerebral Hemorrhage / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D004844:Epistaxis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006417:Hematuria / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D006454:Hemoglobins / Q000032:analysis; D006470:Hemorrhage / Q000097:blood / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007223:Infant; D008297:Male; D010976:Platelet Count; D011446:Prospective Studies; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000097:blood / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D012074:Remission Induction; D012189:Retrospective Studies; D018805:Sepsis / Q000209:etiology; D013630:Tampons, Surgical; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D006454:Hemoglobins; D016756:Immunoglobulins, Intravenous