Severe hemorrhage in children with newly diagnosed immune thrombocytopenic purpura

Cindy E. Neunert, George R. Buchanan, Paul Imbach, Paula H B Bolton-Maggs, Carolyn M. Bennett, Ellis J. Neufeld, Sara K. Vesely, Leah Adix, Victor S. Blanchette, Thomas Kühne

Research output: Contribution to journalArticle

126 Citations (Scopus)

Abstract

Controversy exists regarding management of children newly diagnosed with immune thrombocytopenic purpura (ITP). Drug treatment is usually administered to prevent severe hemorrhage, although the definition and frequency of severe bleeding are poorly characterized. Accordingly, the Intercontinental Childhood ITP Study Group (ICIS) conducted a prospective registry defining severe hemorrhage at diagnosis and during the following 28 days in children with ITP. Of 1106 ITP patients enrolled, 863 were eligible and evaluable for bleeding severity assessment at diagnosis and during the subsequent 4 weeks. Twenty-five children (2.9%) had severe bleeding at diagnosis. Among 505 patients with a platelet count less than or equal to 20 000/mm3 and no or mild bleeding at diagnosis, 3 (0.6%), had new severe hemorrhagic events during the ensuing 28 days. Subsequent development of severe hemorrhage was unrelated to initial management (P = .82). These results show that severe bleeding is uncommon at diagnosis in children with ITP and rare during the next 4 weeks irrespective of treatment given. We conclude that it would be difficult to design an adequately powered therapeutic trial aimed at demonstrating prevention of severe bleeding during the first 4 weeks after diagnosis. This finding suggests that future studies of ITP management should emphasize other outcomes.

Original languageEnglish (US)
Pages (from-to)4003-4008
Number of pages6
JournalBlood
Volume112
Issue number10
DOIs
StatePublished - Nov 15 2008

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Idiopathic Thrombocytopenic Purpura
Hemorrhage
Drug therapy
Platelets
Platelet Count
Registries
Therapeutics

ASJC Scopus subject areas

  • Hematology
  • Biochemistry
  • Cell Biology
  • Immunology

Cite this

Neunert, C. E., Buchanan, G. R., Imbach, P., Bolton-Maggs, P. H. B., Bennett, C. M., Neufeld, E. J., ... Kühne, T. (2008). Severe hemorrhage in children with newly diagnosed immune thrombocytopenic purpura. Blood, 112(10), 4003-4008. https://doi.org/10.1182/blood-2008-03-138487

Severe hemorrhage in children with newly diagnosed immune thrombocytopenic purpura. / Neunert, Cindy E.; Buchanan, George R.; Imbach, Paul; Bolton-Maggs, Paula H B; Bennett, Carolyn M.; Neufeld, Ellis J.; Vesely, Sara K.; Adix, Leah; Blanchette, Victor S.; Kühne, Thomas.

In: Blood, Vol. 112, No. 10, 15.11.2008, p. 4003-4008.

Research output: Contribution to journalArticle

Neunert, CE, Buchanan, GR, Imbach, P, Bolton-Maggs, PHB, Bennett, CM, Neufeld, EJ, Vesely, SK, Adix, L, Blanchette, VS & Kühne, T 2008, 'Severe hemorrhage in children with newly diagnosed immune thrombocytopenic purpura', Blood, vol. 112, no. 10, pp. 4003-4008. https://doi.org/10.1182/blood-2008-03-138487
Neunert CE, Buchanan GR, Imbach P, Bolton-Maggs PHB, Bennett CM, Neufeld EJ et al. Severe hemorrhage in children with newly diagnosed immune thrombocytopenic purpura. Blood. 2008 Nov 15;112(10):4003-4008. https://doi.org/10.1182/blood-2008-03-138487
Neunert, Cindy E. ; Buchanan, George R. ; Imbach, Paul ; Bolton-Maggs, Paula H B ; Bennett, Carolyn M. ; Neufeld, Ellis J. ; Vesely, Sara K. ; Adix, Leah ; Blanchette, Victor S. ; Kühne, Thomas. / Severe hemorrhage in children with newly diagnosed immune thrombocytopenic purpura. In: Blood. 2008 ; Vol. 112, No. 10. pp. 4003-4008.
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