Intracranial hemorrhage in children with immune thrombocytopenic purpura

We sent questionnaires to hospitals in Japan in order to study the incidenc e and conditions of intracranial hemorrhage (ICH) in children with immune t hrombocytopenic purpura (ITP). From 1980 to 1995, 11 cases of ICH were repo rted in eight patients with ITP at 35 institutions. One patient had ICH fou r times, but only one patient died of the condition. From 1990 through 1995 , ICH occurred in four (0.52%) of 772 patients with ITP. None of the patien ts died. The platelet count when ICH occurred was 5.2+/-3.7 x 10(9)/l (mean +/-SD) (n = 11). Four of the eight patients (1980-1995) had received active treatment [e.g. intravenous immunoglobulin G (i.v. IgG)I immediately befor e ICH occurred. In seven cases (1980-1995), possible causes of ICH, includi ng menstruation (n = 2) and viral infections (n = 3), were identified. Syst emic lupus erythematosus (SLE) later developed in three patients. Although the incidence of ICH in children with ITP has not decreased compared with t he rates in earlier studies, the mortality rate has decreased markedly. Our results suggest that menstruation, infection, and risk factors for progres sion to SLE may help to predict ICH in children with ITP. Large-scale prosp ective trials are needed to identify risk factors for ICH.