Intracranial hemorrhage in primary immune thrombocytopenia (ITP): 20 years' experience in pediatrics

Incidence of intracranial hemorrhage (ICH) among children with primary immune thrombocytopenia (ITP) varies among different studies. We published data during the period of 1997-2007 of ICH in children with primary ITP, addressing risk factors and outcome. The aim of this study is to assess changes in incidence, risk factors, and outcome of ICH in children with ITP from last decade and to report the overall 20 years' experience. We compared 2008-2018 with the decade before it. Data of children with ITP and ICH during study period and ITP control cases were analyzed. Neurosurgical intervention and outcome were also reported. A total of 4340 children with primary ITP were evaluated. Twenty-five (0.63%) ICH events were reported over 2 decades. Head trauma, hematuria, and platelet counts < 10 x 109/L were the risk factors mostly associated with ICH. Overall mortality was 24%, and a further 28% had neurologic sequelae. Neurosurgical intervention was done in 12% of cases with good outcome. Conclusion: Persistent platelet counts < 10 x 109/L were a significant risk factor for ICH in both time periods, while head trauma and hematuria were more reported in the period of 2008-2018 as significant risk factors for ICH. Outcome was comparable in both periods. What is Known: center dot ICH is a rare complication of ITP; however, early recognition of risk factors and aggressive treatment might lead to complete recovery without sequalae. Platelet counts less than < 10 x 109/L are the main risk factor for ICH. Few studies reported other significant risk factors. What is New: center dot Hematuria and head trauma are significant risk factors for ICH in ITP, in addition to having a persistently low platelet count < 10 x 109/L. (more than 90 days in chronic ITP, 45 days in persistent and 21 days in acute ITP) center dot Combined treatment with IVIG and HDMP followed by platelet transfusion was associated with complete recovery without sequelae in almost 50% of patients.

Automated summary

This study evaluated the changes in incidence, risk factors, and outcomes of ICH in children with ITP over different time periods. It found that persistent low platelet counts < 10 x 10^9/L were significant risk factors for ICH in both time periods, while head trauma and hematuria were more commonly associated with ICH in the most recent study. Outcome was found to be comparable in both time periods.