Department of Pediatric Hematology/Oncology, Ain Shams University, Cairo, Egypt.
Ain Shams University Hospital, Cairo, 11566, Egypt.
Eur J Pediatr. 2021 May;180(5):1545-1552. doi: 10.1007/s00431-020-03923-x. Epub 2021 Jan 15.
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 × 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 × 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: • 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 × 109/L are the main risk factor for ICH. Few studies reported other significant risk factors. What is New: • Hematuria and head trauma are significant risk factors for ICH in ITP, in addition to having a persistently low platelet count < 10 × 109/L. (more than 90 days in chronic ITP, 45 days in persistent and 21 days in acute ITP) • Combined treatment with IVIG and HDMP followed by platelet transfusion was associated with complete recovery without sequelae in almost 50% of patients.
儿童原发性免疫性血小板减少症（ITP）并发颅内出血（ICH）的发生率在不同研究中有所差异。我们曾发表过 1997-2007 年儿童 ITP 并发 ICH 的相关数据，内容涉及ICH 的危险因素和结局。本研究旨在评估过去十年中 ITP 患儿ICH 的发生率、危险因素和结局的变化，并报告过去 20 年的总体经验。我们比较了 2008-2018 年与之前十年的数据。分析了研究期间 ITP 合并 ICH 患儿和 ITP 对照组的数据。还报告了神经外科干预和结局。共评估了 4340 例原发性 ITP 患儿。20 年来共报告了 25 例（0.63%）ICH 事件。头部外伤、血尿和血小板计数<10×109/L 是与 ICH 最相关的危险因素。总的死亡率为 24%，另有 28%存在神经后遗症。12%的病例接受了神经外科干预，结果良好。结论：血小板计数持续<10×109/L 是两个时期ICH 的显著危险因素，而头部外伤和血尿在 2008-2018 年期间作为ICH 的显著危险因素更为常见。两个时期的结局相似。已知情况：• ICH 是 ITP 的罕见并发症；然而，早期识别危险因素并积极治疗可能会导致完全康复而无后遗症。血小板计数<10×109/L 是 ICH 的主要危险因素。少数研究报告了其他显著的危险因素。新情况：• ITP 患儿发生 ICH 的除血小板计数持续<10×109/L 外，血尿和头部外伤也是显著危险因素。（慢性 ITP 中持续时间超过 90 天，持续性 ITP 中持续时间为 45 天，急性 ITP 中持续时间为 21 天）• IVIG 和 HDMP 联合治疗后血小板输注与近 50%的患者完全康复且无后遗症相关。
