Duration and morbidity of chronic immune thrombocytopenic purpura in children: Five-year follow-up of a Nordic cohort

Aim:  To describe the clinical course, morbidity and platelet recovery in an unselected Nordic cohort of children with chronic Immune Thrombocytopenic Purpura (ITP). Methods:  Prospective 5-year follow-up of 96 children with ITP lasting more than 6 months, with reporting of hospital admissions, severity of bleeding episodes, and stabilization of platelet counts above 20, 50 and 150 x 10(9) /L. Results:  The estimated 5-year recovery rate was 52%; exclusion of 12 splenectomized children did not change the estimate. Events eliciting admission to hospital occurred in 39 (41%). Major hemorrhages occurred in 8 children (8%), including a non-fatal intracranial hemorrhage in one child (1%). The overall admission rate was 0.4 per year of thrombocytopenia, decreasing during follow-up as thrombocytopenia converted to milder degrees. Early recovery within 2 years of diagnosis occurred in 35%, was associated with low morbidity, and was more likely in young children with abrupt onset of symptoms. Conclusion:  In a Nordic cohort of children with chronic ITP one half had recovered 5 years after diagnosis, more than half never required hospitalization, and less than 10% experienced serious bleeding episodes, always with a platelet count