The Bleeding Risk and Natural History of Idiopathic Thrombocytopenic Purpura in Patients With Persistent Low Platelet Counts

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Abstract
ADULT idiopathic thrombocytopenic purpura (ITP) is a relatively common and easily recognizable bleeding disorder. Nonetheless, the natural history of this condition is unknown.1 The course and prognosis of ITP is mainly determined by the risk of spontaneous bleeding associated with low platelet counts.1,2 The American Society of Hematology (ASH) ITP guideline panel recently published their conclusions based on a systematic review of clinical series.2 They estimated that the risk of fatal hemorrhage was approximately 5% throughout the lifetime of a patient with ITP. However, this estimate is an average risk obtained in a heterogeneous group of patients. It included both patients who had favorable responses to therapy, and those who remained refractory.