الفهرس 
I MMUNE T HROMBOCYTOPENIA (Only 14 pages are availabe for public view
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Abstract
Background: Idiopathic immune thrombocytopenia (ITP) is a heterogeneous disorder with a diverse natural history and diverse pattern of treatment response in children. Intracranial hemorrhage (ICH) is the most devastating complication of ITP in children. The features that predispose patients to develop ICH in addition to severe thrombocytopenia remain poorly defined. Hemorrhage in ITP patients may also be clinically silent (occult) and thus not readily determined by history and/or physical examination. Brain microbleeds are a radiologic construct visualized through magnetic resonance imaging (MRI) that represent perivascular collections of hemosiderin-laden macrophages and are considered to be silent lesions resulting from previous petechial hemorrhages.
Aim of the work: The aim of this study to investigate the frequency of occult (subclinical) intracranial hemorrhage (ICH) in Egyptian children with ITP as assessed by brain MRI and its relation to different disease characteristics and patients variables.
Methods: This cross-sectional study included 40 patients with ITP aging from3.5 years to 18 years. There were 11 patients with acute, 5 persistent and 24 patients with chronic ITP. We obtained non contrast, T2gradient echo sequence (T2*WI) susceptibility weighted images (SWI) in the axial plane. Focal areas of signal loss with a diameter of up to 5 mm were considered a brain micro bleed. Such ”brain microbleeds” appear dark on T2-weighted spino-echo sequences and T2*WI.
Results: Results showed that acute ITP patients were significantly younger than persistent and chronic patients. chronic ITP patients received more times treatments than acute and persistent and no statistical differences between the types as regards gender, height &weight SDS, systolic &diastolic blood pressure, bleeding score, types of treatments and response to treatments. All patients with brain microbleeds had chronic ITP. No statistical differences were found between patients with occult bleeding and those without as regards demographic, clinical data, bleeding score, type and response to treatment. No significant correlations were found between the initial platelet count& mean platelet count to the disease duration & bleeding score. It shows that 3 out of 40 patients showed brain microbleeds.
Conclusion: Assessment of brain microbleeds in these patients population requires further prospective studies to determine possible pathophysiologic relationships that might have therapeutic implications. Screening for brain microbleeds is essential in some ITP patients especially those with chronic ITP or relapsed ITP.