RECURRENT IDIOPATHIC THROMBOCYTOPENIC PURPURA IN CHILDHOOD

INTRODUCTION: Idiopathic thrombocytopenic purpura (ITP) is usually a benign disease that remits within weeks to years. The literature on recurrent ITP (rITP) is limited. OBJECTIVE: The aim of this study was to retrospectively review patients with rITP who were followed up during the period of 1975–2004. METHODS: We reviewed the outcome of 790 children with rITP RESULTS: Among 790 children with ITP, 47 (5.2%) presented with >1 episode of thrombocytopenia. The median age of the children at onset of the disease was 55.9 ± 35.3 months and at final remission was 94.4 ± 58.9 months. The majority of patients (76.6%) had 1 recurrence, whereas the rest of them had >1 recurrence (up to 4); the total number of recurrences was 63. The interval between 2 episodes was 3 years in 14%. Almost half the patients demonstrated bleeding manifestations at diagnosis, whereas only a minority (5) showed bleeding symptoms during the first recurrence. Hemorrhages occurred at times of severe thrombocytopenia and were, in general, mild; however, 1 patient suffered intracranial hemorrhage. Of the episodes, 28.6% necessitated hospitalization and 17.5% required therapeutic intervention with corticosteroids or/and intravenous immunoglobulin. The long-term outcome of all patients was excellent, and none of them needed splenectomy. CONCLUSIONS: rITP occurs mostly in young children, has a good outcome after >1 to 5 episodes, and a median age that ranges from months to years. The course is more often benign; however, life-threatening hemorrhage may occur in a severely thrombocytopenic patient.