Retrospective Review of Life-Threatening Bleeds in Paediatric ITP.

Abstract 4453

Immune thrombocytopenia (ITP) is an uncommon disorder of childhood. Most children recover quickly regardless of intervention, but severe bleeding develops in approximately 3%. Intracranial haemorrhage (ICH) is by far the most feared complication, occurring in 0.1-0.5%. Pharmacotherapy is available to transiently increase platelet counts, but introduction of British clinical guidelines in 1992 has resulted in a sharp decline in the number of children receiving such treatment.

The aim of this survey is to establish the current UK incidence of intracranial and other life-threatening haemorrhages in ITP, and whether or not children developing such complications have other risk factors for bleeding.

UK paediatricians were mailed a questionnaire asking to report the number of cases of ITP per year, and any cases of intracranial haemorrhages (ICH) in the previous ten years or other life-threatening haemorrhages in the past five years. Consultants reporting patients were asked to complete a form requesting detailed information on the child and the circumstances surrounding their bleed.

844 annual cases of ITP were reported from 145 centres; 672 of these were acute presentations and 240 were chronic. 24 cases of ICH and 19 cases of life-threatening bleed were identified, giving an annual incidence of 0.3% and 0.5% respectively. Gastrointestinal haemorrhage was the most commonly reported life-threatening bleed, and in six cases, ICH and life-threatening bleeds occurred in the same child.

The incidence of ICH in ITP may be higher than previously reported in the UK; the reason behind this increase remains unknown and support the need for larger international collaborative studies.