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O objetivo deste trabalho foi determinar a frequência dos quadros clínicos da púrpura trombocitopênica imune e sua associação com contagem de plaquetas, taxa de resposta à esplenectomia e fatores preditivos do desfecho e da evolução para a cronicidade. Realizou-se estudo retrospectivo com 187 crianças diagnosticadas no Hospital das Clínicas da UFMG, entre 04/1988 e 12/2001. Quadros assintomáticos e leves corresponderam a 76% do total. Hemorragias exclusivamente cutâneas ocorreram em 96% dos casos sintomáticos. A gravidade dos sintomas associou-se à intensidade da plaquetopenia. Evolução aguda foi apresentada por 123 pacientes (70,7%) e crônica por 51 (29,3%). A apresentação insidiosa (26,2%) associou-se a um maior número de esplenectomias (p=4x10-7), a uma menor taxa de resposta à corticoterapia (p=0,003) e constituiu-se, juntamente com a ausência de resposta à corticoterapia (pThe objective of this work was to determine the frequency of clinical manifestations of immune thrombocytopenic purpura and its association with platelet count, response to splenectomy and predictive factors for response and chronicity. This retrospective study included 187 children diagnosed at Hospital das Clínicas, Federal University of Minas Gerais, Brazil, between April 1988 and December 2001. About 76% of the cases had asymptomatic or clinically mild disease. Cutaneous bleeding alone was seen in 96% of the symptomatic cases. Severity of symptoms was associated with low platelet count. The acute disease was observed in 123 patients (70.7%) and 51 (29.3%) developed the chronic disease. Insidious presentation (26.2%) was associated with a larger number of splenectomies (p=4x10-7) and with a reduced response to steroids (p=0.003). Additionally, the lack of response to steroids (p