Immune thrombocytopenia (ITP) is an acquired thrombocytopenia caused by auto-antibodies against platelet antigens. Over the last 20 years numerous reports of venous thromboembolic complications with ITP patients have been published, including several large-scale population-based studies. However, data in children is scarce. Herein we report four cases of pediatric patients who were found to have cerebral venous sinus thrombosis (CSVT) after ITP. These cases and prior literature raise the possibility of ITP, and or its treatment being a thrombotic risk factor.

The present study sought to report 4 cases of CSVT in the setting of ITP.

Chart review of 4 patients who presented with CSVT following a diagnosis of ITP were conducted. Parental consent was obtained.

Four male patients with mean age of CSVT presentation being 6 years (3-10 years of age), who developed CSVT post ITP, received therapeutic anticoagulation. They did not develop bleeding complications while on anticoagulation therapy. All had good clinical outcomes, with partial or complete radiological resolution of thrombosis. Recurrence or extension of CSVT occurred in 3 of 4 patients. Despite having intracranial hemorrhage at the time of the ITP presentation in 2 patients, anticoagulation was still initiated, and did not result in further bleeding.

The etiology of the increased risk of venous thrombosis in patients with ITP is unclear, and it appears to be multifactorial as to why some patients may be prone to thrombosis and others not, and how important the role of treatment is in this complication. However, ITP and or the treatment of ITP may be contributing risk factors for thrombosis. Bleeding remains the most feared complication for patients with ITP. Nevertheless, anticoagulation can be administered, without further bleeding complications. An association between ITP and thrombosis, specifically CSVT in children is possible, but data is lacking in the literature. Further studies are needed to better describe associations between ITP, and thrombotic events in children.