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Cutaneous Hemorrhage Types as Supportive Factors for Predicting Chronic Immune Thrombocytopenia in Children

Kalfon, Sarit, MD*,†; Hamadeh, Haitham, MD*; Schachter, Yaakov, MD*; Sharon, Nechama, MD†,‡

Journal of Pediatric Hematology/Oncology: July 2018 - Volume 40 - Issue 5 - p 337–340
doi: 10.1097/MPH.0000000000001167
Original Articles

Our objective was to assess risk factors for developing chronic immune thrombocytopenia (ITP) in children. The charts of all consecutive children diagnosed with ITP between 2000 and 2015 at a single center were retrospectively reviewed, and clinical characteristics at initial presentation were analyzed. Sixty-two children were included in the study (mean age, 6.15 y); 44 (71%) were found to have acute ITP, and 18 (29%) developed chronic ITP (permanent or relapsing thrombocytopenia >12 mo). In a univariate analysis, cutaneous hemorrhages were observed significantly more in acute patients (90.9%) than in chronic patients (61.1%). Patients who had acute ITP were more likely to present with a combination of petechiae, purpura, and/or ecchymosis (75%) than patients with chronic disease (44.4%, P=0.010). In multivariate analysis, older age increased the risk (odds ratio=1.1; P<0.05) for chronic disease, and manifestations of combination skin hemorrhages (petechiae/purpura/ecchymosis) reduced the risk (odds ratio=0.167; P<0.05). In conclusion, the most important risk factor for chronic disease is older age. Skin hemorrhage types were found to be a supportive factor for the prediction process: the combination of petechia/purpura/ecchymosis was associated with a lower risk for developing chronic disease compared with petechiae alone. Future studies should assess the prognostic value of skin hemorrhage types that are a simple way to predict the course of ITP in children.

*Department of Pediatrics

Division of Pediatric Hematology-Oncology, Laniado Medical Center, Netanya

Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel

The authors declare no conflict of interest.

Reprints: Nechama Sharon, MD, Department of Pediatrics, Division of Pediatric Hematology-Oncology, Laniado Hospital, Netanya 4244916, Israel (e-mail:

Received June 21, 2017

Accepted January 29, 2018

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.