Retrospective Analysis of Patients with Idiopathic Thrombocytopenic Purpura from Eastern Anatolia

Abstract

Objective: We evaluated the clinical features and the effects of various treatment modalities on the clinical course in patients diagnosed with idiopathic thrombocytopenic purpura (ITP). Materials and Methods: Retrospective investigation of the medical records of 168 patients at our center between 1994 and 2005 was done. Results: Of the 168 patients, 115 (68.4%) were women and 53 (31.6%) men. At initial diagnosis, the median age of the patients was 33 years (range: 15–91) and 139 (82.7%) had signs of bleeding. Follow-up was complete in 130 patients and the median follow-up was 27 months (range: 3–132). Initial treatment with either standard or high-dose steroid as first-line therapy was begun in 123 (73.2%) of the 168 patients. Complete remission (CR) was achieved in 56% of the patients. Sixty-one (61) patients who were followed up regularly received second-line therapies. CR was achieved in 45.8% of the patients who received steroids as second-line therapy. Within a median follow-up of 7 months, 27.2% of these patients relapsed. Splenectomy was performed in 26 patients and CR was obtained in 72% of the 25 patients regularly followed up. CR obtained by splenectomy was significantly higher than that obtained by steroids (p < 0.001). The 10-year disease-free survivals in patients who used steroids and who underwent splenectomy were 15 and 61.6%, respectively. Conclusion: Steroid therapy is effective both in the initial and relapse periods. Splenectomy is the treatment of choice for those ITP patients refractory to steroid therapy and younger than 40 years of age.

Thromboembolism in adults with primary immune thrombocytopenia: a systematic literature review and meta‐analysis

“…‘Annualised’ cumulative incidence and risk . Following ITP diagnosis, the pooled ‘annualised’ cumulative risk for TE was 2.97%/yr (Fig. ) and the pooled ‘annualised’ cumulative incidence for TE was 1.29%/yr (Figure S2, Supporting information).…”

The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia

“…88 The decision to treat should be based on the individual patient's severity of bleeding, bleeding risk (eg, previous bleeding episodes, coincident risk factors for bleeding such as hypertension and age), activity level (eg, playing contact sports), likely side effects of treatment, and patient preferences. 85,[89][90][91][92][93][94][95][96][97][98][99][100][101] Women with chronic ITP may have heavy menstrual periods that interfere with their daily activities or result in iron deficiency anemia, both findings that may influence the decision to treat. There is limited evidence on which to base treatment recommendations on a specific platelet count or age for all patients.…”

“…The outcomes from ITP do appear to be improving; the original ASH guideline reported a mortality rate for patients with newly diagnosed ITP between 1928-1989 of 2.1%, compared with a mortality rate of 0.8% in patients with newly diagnosed ITP between 1973-2004 (including papers published after the last ASH review). 85,[89][90][91][92][93][94][95][96][97][99][100][101] Care must be taken in interpreting the estimates of the rates of death as these papers are very heterogeneous. In contrast, mortality for patients with chronic ITP has not improved to the same extent, with a mortality rate of 5.4% (25/465 patients) in the original ASH guideline compared with mortality rates of 6.6% (6/91 patients) in more recently reported studies.…”

Thrombocytopenia in Adults: Review Article

“…Hematuria, cerebral and retinal bleeding, menorrhagia can be seen in women. For the diagnosis of ITP medical history and with the completing physical examining in laboratory researching the reasons which are producing seconder thrombocytopenia should be eliminated [10,11]. The most important laboratory finding is thrombocytopenia and platelet anisocytosis.…”