Seasonal Association of Immune Thrombocytopenia in Adults

Abstract

Background:Immune thrombocytopenia (ITP) is an autoimmune disorder. It is characterized by thrombocytopenia due to thrombocyte destruction mediated by autoantibodies; however, cytotoxic and defective regulatory T-lymphocytes play an important role in its pathogenesis. While childhood ITP is usually acute, self-limiting and generally seasonal in nature, ITP in adults is usually chronic; its relation with seasons has not been studied. Aims: We investigated whether months and/or seasons have triggering roles in adults with ITP. Study Design: Descriptive study. Methods: A retrospective case review of adult patients with primary ITP diagnosed at various University Hospitals in cities where Mediterranean climate is seen was performed. Demographic data, date of referral and treatments were recorded. Corticosteroid-resistant, chronic and refractory cases were determined. Relation between sex, corticosteroid-resistant, chronic and refractory ITP with the seasons was also investigated. Results: The study included 165 patients (124 female, mean age=42.8±16.6). Most cases of primary ITP were diagnosed in the spring (p=0.015). Rates of patients diagnosed according to the seasons were as follows: 35.8% in spring, 23% in summer, 20.6% in fall, and 20.6% in winter. With respect to months, the majority of cases occurred in May (18.2%). Time of diagnosis according to the seasons did not differ between genders (p=0.699). First-line treatment was corticosteroids in 97.3%, but 35% of the cases were corticosteroid-resistant. Steroid-resistant patients were mostly diagnosed in the spring (52.1%) (p=0.001). ITP was chronic in 52.7% of the patients and they were also diagnosed mostly in the spring (62.7%) (p=0.149). Conclusion: This is the first study showing seasonal association of ITP in adults and we have observed that ITP in adults is mostly diagnosed in the spring. The reason why more patients are diagnosed in the spring may be due to the existence of atmospheric pollens reaching maximum levels in the spring in places where a Mediterranean climate is seen.

Seasonal variations in hematological disorders: A 10‐year single‐center experience

“…ITP was the second most common disorder found in our cohort, with female preponderance and most cases being found in southwest monsoon period and peak was found in the month of April. This is similar to international studies, which showed most cases of primary ITP were diagnosed in spring 2,20 . With respect to months, the majority of cases occurred in May 2 .…”

“…A childhood study of seasonality in leukemia has shown peaks of diagnosis in summer season, while in a study on adults, higher incidence was observed in winter season 9,10 . Another study has reported significantly higher incidence of primary ITP in spring season 2 …”

“…Seasonal variations in hematological disorders have been largely reported by several epidemiological studies 1‐10 . Although the etiology behind this could be due to environmental factors or infectious agent, significant seasonal variations have been revealed in many studies 1,2 .…”

“…Seasonal variations in hematological disorders have been largely reported by several epidemiological studies 1‐10 . Although the etiology behind this could be due to environmental factors or infectious agent, significant seasonal variations have been revealed in many studies 1,2 . In particular, many recent studies have reported seasonal variations in hematological disorders such as aplastic anemia (AA), acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), and immune thrombocytopenic purpura (ITP) 1‐4 …”

Relationship of primary immune thrombocytopenic purpura and atopia among children: a case control study

“…Atopic disorders such as allergic conjunctivitis, asthma, allergic rhinitis can occur in other diseases such as Immune thrombocytopenic purpura (ITP). ITP is one of the most common causes of thrombocytopenia and is a syndrome that causes platelet dysfunction 12 . Antiplatelet antibodies secreted by autoreactive B lymphocytes destroy platelets in the reticuloendothelial system, especially the spleen by binding to platelet antigens, which is described as the major immunological defect in ITP 13 .…”