Most patients will initially respond to standard management with first-line corticosteroids, but additional therapies are required in more than half of cases. In general the prognosis is good, with only 2.5% to 5% of patients being refractory to all available treatments, including splenectomy.[102]Beardsley DS. ITP in the 21st Century. Hematology Am Soc Hematol Educ Program. 2006;402-407.
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Prognosis is particularly good in children. Children often recover spontaneously within weeks or months, with higher rates of spontaneous remission associated with younger age.[72]Bennett CM, Neunert C, Grace RF, et al. Predictors of remission in children with newly diagnosed immune thrombocytopenia: data from the Intercontinental Cooperative ITP Study Group Registry II participants. Pediatr Blood Cancer. 2018 Jan;65(1):e26736.
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Studies report complete remission within 6 months in approximately 70% of children with immune thrombocytopenia.[73]Kühne T, Buchanan GR, Zimmerman S, et al. A prospective comparative study of 2540 infants and children with newly diagnosed idiopathic thrombocytopenic purpura (ITP) from the Intercontinental Childhood ITP Study Group. J Pediatr. 2003 Nov;143(5):605-8.
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[74]Despotovic JM, Grimes AB. Pediatric ITP: is it different from adult ITP? Hematology Am Soc Hematol Educ Program. 2018 Nov 30;2018(1):405-11.
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Mortality is higher in older patients and in those unresponsive to several lines of treatment.[36]Portielje JE, Westendorp RG, Kluin-Nelemans HC, et al. Morbidity and mortality in adults with idiopathic thrombocytopenic purpura. Blood. 2001 May 1;97(9):2549-54.
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[103]Cohen YC, Djulbegovic B, Shamai-Lubovitz O, et al. The bleeding risk and natural history of idiopathic thrombocytopenic purpura in patients with persistent low platelet counts. Arch Intern Med. 2000;160:1630-1638.
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[104]Cortelazzo S, Finazzi G, Buelli M, et al. High risk of severe bleeding in aged patients with chronic idiopathic thrombocytopenic purpura. Blood. 1991;77:31-33.
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