Immune thrombocytopenic purpura evolving into aplastic anemia in association with Epstein-Barr virus infection.

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.