Evaluating bleeding severity in children with newly diagnosed immune thrombocytopenia: a pilot study.
BACKGROUND
Childhood immune thrombocytopenia (ITP) is a bleeding disorder characterized by decreased platelet counts. Assessment of the individual bleeding risk during the course of the disease would allow more accurately guiding treatment-related decisions in these patients.


METHODS
We conducted a pilot study and prospectively evaluated platelet counts and bleeding signs using an established bleeding (Buchanan) score in 30 patients with newly diagnosed ITP at 3 different time points (at diagnosis [TP1], on day 2-3 [TP2], and on day 5-8 [TP3]) during the first week after diagnosis. 15 patients received immune modulatory therapy.


RESULTS
Median platelet counts at the 3 different time points were 13, 19, 32×10 (9)/L (untreated patients) and 2, 7, 37×10 (9)/L (treated patients). Corresponding median cumulative bleeding scores were 5, 2, 0 (untreated patients) and 7, 6, 2 (treated patients). Cumulative median bleeding scores and platelet counts were inversely correlated in treated and untreated patients at all 3 time points. Cumulative median bleeding scores significantly decreased in both groups.


CONCLUSIONS
Bleeding signs in children with newly diagnosed ITP rapidly improve within one week after diagnosis. Serial grading of bleeding severity seems to be useful to comprehensively assess and monitor the individual bleeding risk in these patients, but has to be evaluated and validated in a larger cohort.
Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Auenbruggerplatz 30, Graz, Austria. jasmin.pansy@medunigraz.at
J
J
Pansy
M
M
Minkov
R
R
Dengg
F
F
Quehenberger
H
H
Lackner
A
A
Nebl
P
P
Sovinz
W
W
Schwinger
C
C
Urban
M
M
Benesch
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D006470:Hemorrhage / Q000175:diagnosis* / Q000276:immunology* / Q000628:therapy; D006801:Humans; D007116:Immunization, Passive; D008297:Male; D010865:Pilot Projects; D010976:Platelet Count; D011446:Prospective Studies; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000175:diagnosis* / Q000276:immunology* / Q000628:therapy
D000305:Adrenal Cortex Hormones