Immune Thrombocytopenic Purpura Evolving into Aplastic Anemia in Association with Epstein-Barr Virus Infection

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Abstract
Two children with typical findings of acute immune thrombocytopenic purpura (ITP) soon progressed to pancytopenia with severely hypocellular bone marrows. Both were found to have evidence of recent Epstein-Barr virus (EBV) infection. Treatment with anti-thymocyte globulin resulted in a complete remission in one patient and near complete remission in the other. Possible pathophysiologic mechanisms of this transformation are discussed. Children with a diagnosis of ITP who suffer a progressive fall in all hematologic cell lines should be examined for the possibility of EBV-associated aplastic anemia.

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