title: Bleeding manifestations and management of children with persistent and chronic immune thrombocytopenia: data from the Intercontinental Cooperative ITP Study Group (ICIS).
abstract: Long-term follow-up of children with immune thrombocytopenia (ITP) indicates that the majority undergo remission and severe thrombocytopenia is infrequent. Details regarding bleeding manifestations, however, remain poorly categorized. We report here long-term data from the Intercontinental Cooperative ITP Study Group Registry II focusing on natural history, bleeding manifestations, and management. Data on 1345 subjects were collected at diagnosis and at 28 days, 6, 12, and 24 months thereafter. Median platelet counts were 214 × 10(9)/L (interquartile range [IQR] 227, range 1-748), 211 × 10(9)/L (IQR 192, range 1-594), and 215 × 10(9)/L (IQR 198, range 1-598) at 6, 12, and 24 months, respectively, and a platelet count <20 × 10(9)/L was uncommon (7%, 7%, and 4%, respectively). Remission occurred in 37% of patients between 28 days and 6 months, 16% between 6 and 12 months, and 24% between 12 and 24 months. There were no reports of intracranial hemorrhage, and the most common site of bleeding was skin. In patients with severe thrombocytopenia we observed a trend toward more drug treatment with increasing number of bleeding sites. Our data support that ITP is a benign condition for most affected children and that major hemorrhage, even with prolonged severe thrombocytopenia, is rare.
authors.affiliation: Department of Pediatrics, Georgia Regents University, Augusta, GA 30912, USA. cneunert@gru.edu
authors.forename: Cindy E
authors.initials: CE
authors.lastname: Neunert
authors.forename: George R
authors.initials: GR
authors.lastname: Buchanan
authors.forename: Paul
authors.initials: P
authors.lastname: Imbach
authors.forename: Paula H B
authors.initials: PH
authors.lastname: Bolton-Maggs
authors.forename: Carolyn M
authors.initials: CM
authors.lastname: Bennett
authors.forename: Ellis
authors.initials: E
authors.lastname: Neufeld
authors.forename: Sara K
authors.initials: SK
authors.lastname: Vesely
authors.forename: Leah
authors.initials: L
authors.lastname: Adix
authors.forename: Victor S
authors.initials: VS
authors.lastname: Blanchette
authors.forename: Thomas
authors.initials: T
authors.lastname: Kühne
mesh_terms: D000208:Acute Disease; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000276:immunology* / Q000628:therapy*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007223:Infant; D007390:International Agencies; D008297:Male; D010976:Platelet Count; D017713:Platelet Transfusion; D011446:Prospective Studies; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000276:immunology* / Q000628:therapy*; D012042:Registries / Q000706:statistics & numerical data*; D012074:Remission Induction; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013156:Splenectomy; D013256:Steroids / Q000627:therapeutic use
chemical_list: D016756:Immunoglobulins, Intravenous; D013256:Steroids