title: Duration and morbidity of chronic immune thrombocytopenic purpura in children: five-year follow-up of a Nordic cohort.
abstract: OBJECTIVE
  To describe the clinical course, morbidity and platelet recovery in an unselected Nordic cohort of children with chronic Immune Thrombocytopenic Purpura (ITP).
  
  
  METHODS
  Prospective 5-year follow-up of 96 children with ITP lasting more than 6 months, with reporting of hospital admissions, severity of bleeding episodes and stabilization of platelet counts above 20, 50 and 150 × 10(9) /L.
  
  
  RESULTS
  The estimated 5-year recovery rate was 52%; exclusion of 12 splenectomized children did not change the estimate. Events eliciting admission to hospital occurred in 39 (41%). Major haemorrhages occurred in eight children (8%), including a nonfatal intracranial haemorrhage in one child (1%). The overall admission rate was 0.4/year of thrombocytopenia, decreasing during follow-up as thrombocytopenia converted to milder degrees. Early recovery within 2 years of diagnosis occurred in 35%, was associated with low morbidity and was more likely in young children with abrupt onset of symptoms.
  
  
  CONCLUSIONS
  In a Nordic cohort of children with chronic ITP, one half had recovered 5 years after diagnosis, more than half never required hospitalization and <10% experienced serious bleeding episodes, always with a platelet count <20 × 10(9) /L. Aggressive management can be restricted to the minority of children with continuing severe thrombocytopenia and frequent, clinically significant bleeding events.
authors.affiliation: Pediatric Department, Aarhus University Hospital, Aalborg Hospital, Denmark. steen.rosthoej@rn.dk
authors.forename: Steen
authors.initials: S
authors.lastname: Rosthøj
authors.forename: Jukka
authors.initials: J
authors.lastname: Rajantie
authors.forename: Iris
authors.initials: I
authors.lastname: Treutiger
authors.forename: Bernward
authors.initials: B
authors.lastname: Zeller
authors.forename: Ulf
authors.initials: U
authors.lastname: Tedgård
authors.forename: Jan-Inge
authors.initials: JI
authors.lastname: Henter
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008297:Male; D010976:Platelet Count; D011379:Prognosis; D011446:Prospective Studies; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000097:blood / Q000453:epidemiology / Q000628:therapy; D020127:Recovery of Function; D012075:Remission, Spontaneous; D012537:Scandinavian and Nordic Countries / Q000453:epidemiology; D012720:Severity of Illness Index; D013156:Splenectomy; D013997:Time Factors