United Kingdom Experience of Intracranial Bleeds in Childhood Immune Thrombocytopenia

Childhood immune thrombocytopenia (ITP) is an uncommon disease that is usually self-limiting and resolves spontaneously without treatment. Less than 1% of children with ITP will develop an intracranial haemorrhage (ICH). The aim of this project was to review data from all available cases of ICH and identify features associated with an increased risk of intracranial bleeding. The data were obtained from three main resources: patient notes, the UK ITP Registry and surveys sent out to centres across the UK. 19 cases were reviewed, occurring over a period of 12 years from 2004 to 2016.

Platelet counts below 20x10⁹/L were associated with severe bleeding, as were moderate or severe bleeding manifestations beyond cutaneous bleeding in the 28 days leading up to an ICH. Patient comorbidity was also reviewed and a significant number of patients had co-existing issues, including positive autoantibody tests. Presentations of ICH varied. In 10 patients, headache was a presenting feature. 3 patients presented with seizures, and 5 with vomiting. The majority of patients also had at least one active bleeding site in the 28 days before the episode of ICH. The mouth and nose were the most common bleeding sites. The mortality rate was 4/19, 21%. Neurological disability on discharge was present in 4/15, 27% of the patients who survived. Most identified risk factors for ICH were consistent with previous research, however none had an arteriovenous malformation and only three of 19 cases were documented to have experienced head trauma prior to ICH. Based on UK ITP registry data the incidence of ICH is estimated to bet 0.14-0.57% of paediatric ITP patients.