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Blood, 15 November 2008, Vol. 112, No. 10, pp. 4003-4008. Prepublished online as a Blood First Edition Paper on August 12, 2008; DOI 10.1182/blood-2008-03-138487. This Article Full Text Full Text (PDF) Supplemental Appendix All Versions of this Article: blood-2008-03-138487v1 112/10/4003    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Neunert, C. E. Articles by Kühne, T. Search for Related Content PubMed PubMed Citation Articles by Neunert, C. E. Articles by Kühne, T. Related Collections Hemostasis, Thrombosis, and Vascular Biology Free Research Articles Clinical Trials and Observations Related Article in Blood Online Social Bookmarking                   What's this?  Previous Article  |  Table of Contents  |  Next Article  CLINICAL TRIALS AND OBSERVATIONS Severe hemorrhage in children with newly diagnosed immune thrombocytopenic purpura Cindy E. Neunert1,2, George R. Buchanan1,2, Paul Imbach3, Paula H. B. Bolton-Maggs4, Carolyn M. Bennett5, Ellis J. Neufeld5, Sara K. Vesely6, Leah Adix2, Victor S. Blanchette7, Thomas Kühne3, for the Intercontinental Childhood ITP Study Group Registry II Participants 1 University of Texas Southwestern Medical Center at Dallas; 2 Children's Medical Center, Dallas TX; 3 University Children's Hospital, Basel, Switzerland; 4 Manchester Royal Infirmary, Manchester, United Kingdom; 5 Children's Hospital Boston, MA; 6 University of Oklahoma Health Sciences Center, Oklahoma City; and 7 Hospital for Sick Children, Toronto, ON 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. CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? Related Article in Blood Online: Childhood ITP: can we venture below 20 000? Thomas Abshire Blood 2008 112: 3918-3919. [Full Text] [PDF] This article has been cited by other articles: B. Psaila, A. Petrovic, L. K. Page, J. Menell, M. Schonholz, and J. B. Bussel Intracranial hemorrhage (ICH) in children with immune thrombocytopenia (ITP): study of 40 cases Blood, November 26, 2009; 114(23): 4777 - 4783. [Abstract] [Full Text] [PDF] D. B. Cines, J. B. Bussel, H. A. Liebman, and E. T. Luning Prak The ITP syndrome: pathogenic and clinical diversity Blood, June 25, 2009; 113(26): 6511 - 6521. [Abstract] [Full Text] [PDF]

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