Intracranial hemorrhage (ICH) is a rare but major cause of death in immune thrombocytopenic purpura (ITP). The authors reviewed data of 1,840 patient with ITP, from 5 pediatric hematology centers in Egypt from 1997 to 2007, to study the incidence and risk factors of ICH. Ten cases of ICH were identified with a median age at presentation of 7.5 years; 4 patients had acute ITP, 2 persistent and 4 chronic. The platelet count was <10 × 109/l in 7 cases, and only 1 patient had a history of head trauma. Seven children were on treatment prior to or at the time of occurrence of ICH and all were treated by pharmacotherapy. Two children died shortly afterwards due to late referral to a specialized center. Our results suggest that treatment does not prevent ICH and that it can occur at any time during the course of the disease. Delayed referral can be considered a risk factor for unfavorable outcome of ICH, highlighting the importance of teaching sessions for patients and their parents to minimize subsequent morbidity and mortality of ICH in children with ITP.

Khalifa AS, Tolba KA, El Alfy MS, Gadallah M, Ibrahim FH: Idiopathic thrombocytopenic purpura in Egyptian children. Acta Haematol 1993;90:125–129.
Cines DB, Blanchette VS: Immune thrombocytopenic purpura. N Engl J Med 2002;346:995–1008.
Kuhne T, Buchanan G, Zimmerman S, Michaels L, Kohan R, Berchtold W, Imbach P, for the Intercontinental Childhood ITP study Group: A prospective comparative study of 2,450 infants and children with diagnosed idiopathic thrombocytopenic purpura (ITP) from the Intercontinental Childhood ITP Study Group. J Pediatr 2003;143:605–608.
Butros LJ, Bussel JB: Intracranial hemorrhage in immune thrombocytopenic purpura: a retrospective analysis. Clinical and laboratory observations. J Pediatr Hematol Oncol 2003;25:660–664.
Watts RG: Idiopathic thrombocytopenic purpura: a 10-year natural history study at the childrens hospital of Alabama. Clin Pediatr 2004;43:619–702.
Medeiros D, Buchanan GR: Major intracranial hemorrhage in children with idiopathic thrombocytopenic purpura: immediate response to therapy and long-term outcome. J Pediatr 1998;133:334–339.
Kelton JG, Bussel JB: Idiopathic immune thrombocytopenic purpura: an update. Semin Haematol 2000;37:219–221.
Blanchette VS, Luke B, Andrew M, Sommerville-Nielsen S, Barnard D, de Veber B, Gent M: A prospective randomized trial of high dose immunoglobulin G therapy, oral prednisone therapy and no therapy in childhood immune thrombocytopenic purpura. J Pediatr 1993;123:989–995.
Choudary D, Naithani R, Mahapatra M, Kumar R, Mishra P, Saxena R: Intracranial hemorrhage in childhood immune thrombocytopenic purpura. Pediatr Blood Cancer 2009;52:529–531.
Egyptian Society of Pediatric Hematology and Oncology (ESPHO) guidelines for management of immune thrombocytopenic purpura in children. ESPHO education abstract book, March 2003, pp 24–28.
Cohen YC, Djulbegovic B, Shamai-Lubovitz O, Mozes B: The bleeding risk and natural history of idiopathic thrombocytopenic purpura in patients with persistent low platelet counts. Arch Intern Med 2000;160:1630–1638.
Akatsuka J, Takaeda T, Taguchi N, Tsukimoto N, Nagao D, Nakahata T, Miyazaki S, Akabane T, Tsujino G, Maekawa T: Long term follow up of children with chronic ITP in Japan. The reports of idiopathic disorders of hematopoietic organs from the Japanese Ministry of Health and Welfare. Gunma 1985, pp 384–388.
Iyori H, Bessho F, Ookawa H, Konishi S, Shirahata A, Miyazaki S, Fujisawa K, Akatsuka J, Japanese Study Group on childhood ITP: Intracranial hemorrhage in children with immune thrombocytopenic purpura. Ann Hematol 2000;79:691–695.
Kocak U, Aral YZ, Kaya Z, Oztürk G, Gürsel T: Evaluation of clinical characteristics, diagnosis and management in childhood immune thrombocytopenic purpura: a single center’s experience. Turk J Pediatr 2007;49:250–255.
Ayra LS, Jain Y, Narain S, Choudhry VP, Pati HP: Spontaneous intracranial hemorrhage in children with immune thrombocytopenic purpura. Indian Pediatr 2002;39:468–472.
Imbach P, Zimmerman S: Local and cultural aspects of childhood idiopathic thrombocytopenic purpura: a summary of statements from the 12 countries worldwide. J Pediatr Hematol Oncol 2003;25:S68–S73.
Zeller B, Rajantie J, Hedlund-Treutiger I, Tedgard U, Wesenberg F, Jonsson O, Henter J, Rosthoj S, on behalf of the NOPHO ITP Working Group and five national study groups: Childhood idiopathic thrombocytopenic purpura in the Nordic countries: epidemiology and predictors of chronic disease. Acta Pediatr 2005;94:178–184.
Lilleyman JS: Intracranial hemorrhage in idiopathic thrombocytopenic purpura. Arch Dis Child 1994;71:251–253.
Bolton-Maggs P, Tarantino M, Buchanan G, Bussel J, George J: The child with immune thrombocytopenic purpura: is pharmacotherapy or watchful waiting the best initial management? A panel discussion from the 2002 Meeting of the American Society of Pediatric Hematology/Oncology. J Pediatr Hematol Oncol 2004;26:146–151.
Lusher JM, Emami A, Ravindranath Y, Warrier AI: Idiopathic thrombocytopenic purpura in children: the case for management without corticosteroids. Am J Pediatr Hematol Oncol 1984;6:149–157.
Seckin H, Kazanci A, Yigitkanli K, Simsek H, Zafer Kars H: Chronic subdural hematoma in patients with idiopathic thrombocytopenic purpura: a case report and review of literature. Surg Neurol 2006;66:411–414.
Panicker JN, Pavithran K, Thomas M: Management of subdural hematoma in immune thrombocytopenic purpura: report of seven patients and a literature review. Clin Neurol Neurosurg 2009;111:189–192.
Bay A, Oner AF, Etlik O, Casksen H: A case of immune thrombocytopenic purpura presenting with recurrent intracranial hemorrhage. Pediatr Int 2005;47:109–111.
Brenner B, Guilburd JN, Tatarsky I, Doron Y, Goldsher D: Spontaneous intracranial hemorrhage in immune thrombocytopenic purpura. Neurosurgery 1988;2:761–764.
Lee SL, Kim WC: Intracranial hemorrhage associated with idiopathic thrombocytopenic purpura; report of seven patients and a meta-analysis. Neurology 1998;50:1160–1163.
Medeiros D, Buchanan GR: Current controver- sies in the management of idiopathic thrombocytopenic purpura during childhood. Pediatr Clin North Am 1996;43:757–772.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.