Fifteen years of pediatric immune thrombocytopenia in a national cohortPregeljc, Katja (Avtor) Favaretto, Elena (Avtor) Verzegnassi, Federico (Avtor) Faganel Kotnik, Barbara (Avtor) Alternative diagnoseschronicitycomplicationsimmune thrombocytopeniapediatricswatch- and-wait managementBackground The majority of children with primary immune thrombocytopenia (ITP) follow a benign, self-limiting course. However, early identification of children at risk for chronic disease, timely recognition of alternative diagnoses that may mimic ITP at onset, and selection of patients for observation alone remain important clinical challenges. Methods This retrospective single-center study included patients aged ≤18 years who were evaluated for ITP between 2009 and 2024. Demographic, clinical, laboratory, and therapeutic data were collected at diagnosis and during follow-up. Factors associated with chronic ITP were assessed using logistic regression, providing odds ratios with 95% confidence intervals. Kaplan-Meier analysis was used to describe time to first bleeding complication according to initial management. Results A total of 271 patients were included (43.5% female; median age 4 years). Of these, 240 were ultimately diagnosed with ITP, while 31 received an alternative final diagnosis. In multivariate logistic regression, chronic ITP was independently associated with older age (OR 1.08; p=0.017), absence of a preceding infection or vaccination (OR 0.45; p=0.029), and higher platelet count at diagnosis (OR 1.03, p<0.0001). Compared with patients with final ITP, those with alternative causes of thrombocytopenia were older (p=0.034), had lower bleeding grades (p=0.037), higher MCV, and lower total leukocyte, lymphocyte, monocyte, and eosinophil counts at onset (all p<0.05). Patients receiving upfront pharmacological therapy were younger and presented with higher bleeding grades and lower platelet counts than those managed with observation. Bleeding complications were more frequent with upfront pharmacological therapy, whereas those in the watch-and-wait group tended to be more severe. Conclusion Our results suggest that readily available data may help identify children at risk for chronic disease and those whose thrombocytopenia is attributable to a cause other than ITP. Initial treatment decisions appeared to be driven primarily by clinical presentation.20262026-07-23 10:37:57Neznano31243UDK: 616-053.2ISSN pri članku: 2296-2360DOI: 10.3389/fped.2026.1864433COBISS_ID: 280189187sl