Department of Paediatrics and Adolescent Medicine, Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong, China.
Hong Kong Med J. 2013 Apr;19(2):129-34.
To evaluate potential risk factors, presenting symptoms, management, and outcomes of intracranial haemorrhage in Chinese children with immune thrombocytopenia managed in a regional hospital.
Retrospective case series.
A regional hospital in Hong Kong.
All paediatric patients with immune thrombocytopenia complicated by intracranial haemorrhage in the period January 1996 to December 2009.
Nine episodes of intracranial haemorrhage were reported in eight patients (aged 0.9 to 19 years) with immune thrombocytopenia; three of the patients had acute immune thrombocytopenia and the other five had chronic immune thrombocytopenia. Intracranial haemorrhage occurred as early as the initial presentation with immune thrombocytopenia (n=2) and as late as up to 5 years after the diagnosis. The median platelet count at the time of intracranial haemorrhage was 12 x 10(9) /L (<10 x 10(9) /L [n=4]; 10-20 x 10(9) /L [n=2]; >20 x 10(9) /L [n=3]). The bleeding was considered spontaneous in six episodes, while head trauma (n=2) and vascular malformation (n=1) were identified in three patients with mild-to-moderate thrombocytopenia (42-82 x 10(9) /L) at the time of the bleed. Headache and mucosal bleeding were the commonest presenting symptoms (n=5). All patients received multimodal treatment after diagnosis of intracranial haemorrhage, and included platelet transfusion (n=8), intravenous immunoglobulin (n=6), methylprednisolone (n=4), and splenectomy (n=4); three individuals underwent neurosurgical interventions. One (11%) patient died of posterior fossa bleeding and one (11%) had neurological sequelae. All survivors achieved remission of their immune thrombocytopenia with a median follow-up of 5.3 years.
Intracranial haemorrhage can occur anytime during the course of immune thrombocytopenia. A high index of suspicion for intracranial haemorrhage should be maintained during follow-up, as favourable outcomes can be achieved after early and vigorous interventions.
评估中国某地区医院诊治的免疫性血小板减少症患儿并发颅内出血的潜在危险因素、临床表现、治疗方法和结局。
回顾性病例系列研究。
中国香港某地区医院。
1996 年 1 月至 2009 年 12 月期间，所有免疫性血小板减少症并发颅内出血的儿科患者。
8 例患儿（年龄 0.9 至 19 岁）共发生 9 次颅内出血。3 例患儿为急性免疫性血小板减少症，5 例为慢性免疫性血小板减少症。颅内出血可发生在免疫性血小板减少症初始表现时（n=2），也可发生在诊断后 5 年（n=1）。颅内出血时血小板计数中位数为 12×10⁹/L（＜10×10⁹/L[n=4]；10-20×10⁹/L[n=2]；＞20×10⁹/L[n=3]）。6 次出血被认为是自发性的，而在 3 例血小板计数轻度至中度减少（42-82×10⁹/L）患儿中，有 2 例存在头部创伤（n=2）和 1 例存在血管畸形（n=1）。头痛和黏膜出血是最常见的表现症状（n=5）。所有患者在诊断为颅内出血后均接受了多模式治疗，包括血小板输注（n=8）、静脉注射免疫球蛋白（n=6）、甲基强的松龙（n=4）和脾切除术（n=4）；3 人接受了神经外科干预。1 例（11%）患者因后颅窝出血死亡，1 例（11%）有神经后遗症。所有幸存者的免疫性血小板减少症均获得缓解，中位随访时间为 5.3 年。
免疫性血小板减少症过程中任何时间均可发生颅内出血。在随访过程中应保持对颅内出血的高度警惕，因为早期积极干预可获得良好结局。
