Intracranial haemorrhage in childhood immune thrombocytopenia: A national retrospective study

Introduction. Childhood immune thrombocytopenia (ITP) is usually a benign, self-recovering disorder. Intracranial haemorrhage (ICH) is a very seldom, but life threatening event. Limited data are available. This study evaluates potential risk factors, presenting symptoms, management and outcomes of intracranial haemorrhage in children with immune thrombocytopenia managed in France. Methods. Fourteen cases of ITP complicated with ICH have been studied over a retrospective 20-year period (1993-2013) in France. Results. At diagnosis of ICH, all the patients presented severe thrombocytopenia with a count of platelets < 10 G/L. Eight patients had inaugural or early ICH (< 7 days after ITP onset). Buchanan's score was >= 3 in eight out of 14 cases and a predisposing factor for ICH has been found in four out of the six patients having a Buchanan's score below 3. All but the four with inaugural ITP were under treatment when ICH has occurred. Five children died and one had neurologic sequelae. Conclusion. ICH is a serious and unpredictable event. Early treatment does not seem to prevent it. One should always look after suggestive clinical signs of this complication, as it requires a prompt management including immunoglobulins, steroids and platelet infusions. The use of thrombopoietin receptor agonists and other drugs still has to be defined. (C) 2014 Elsevier Masson SAS. All rights reserved.