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

J Pediatr Hematol Oncol. 2018 Jul;40(5):337-340. doi: 10.1097/MPH.0000000000001167.


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.

Publication types

  • Clinical Trial

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Chronic Disease
  • Female
  • Hemorrhage / diagnosis
  • Hemorrhage / epidemiology
  • Hemorrhage / etiology
  • Humans
  • Male
  • Prognosis
  • Purpura, Thrombocytopenic, Idiopathic* / complications
  • Purpura, Thrombocytopenic, Idiopathic* / diagnosis
  • Purpura, Thrombocytopenic, Idiopathic* / epidemiology
  • Retrospective Studies
  • Risk Factors
  • Skin Diseases* / diagnosis
  • Skin Diseases* / epidemiology
  • Skin Diseases* / etiology