Retrospective population-based review of autoimmunemediated thrombocytopenic purpura (ITP) in olmsted county 1973-1993

Stephan D. Thome, Michelle A. Neben

Research output: Contribution to journalArticle

Abstract

Objectives: To determine the incidence, presentation, management and prognosis of autoimmune thrombocytopenic purpura in a defined population (Olmsted County). Methods: Retrospective chart review of all Olmsted County residents with a diagnosis of ITP between 1973 and 1993. The diagnosis of ITP was based on criteria as defined in the recent ASH guidelines. Results: We identified 71 patients with ITP. There were 47 females and 24 males. The median age at diagnosis was 24.5 years, (range 1.5-89.3). Most common presentation was petechiae/hematoma (27), followed by epistaxis/mild menorrhagia (19). ITP was an incidental finding in 17 asymptomatic patients who had complete blood counts for unrelated reasons. 5 patients presented with hemorrhage requiring emergent intervention. In 3 patients the presentation was unknown. In 16 patients exposure to drugs associated with ITP was documented but no specific testing for drug-associated antibodies was performed (8 sulfa, 3 heparin, 2 quinine, 2 thiazide). Systemic lupus erythematosus was associated with ITP in 5 patients, chronic lymphocytic leukemia in 2, sarcoid in 1. 49 patients received steroids, which was the only treatment in 36 patients. 22 patients underwent splenectomy. 7 patients each received androgens and chemotherapy respectively. 12 patients suffered major bleeding complications (4 gastrointestinal, gynecological and epistaxis each). 45 patients achieved durable complete remission (defined as normal platelet counts for greater than 5 years without treatments), 6 had no response (defined as platelet counts less than 50) and 20 had partial remission (not fitting either category). The median age of patients with CR, PR and NR was 19.5, 47 and 60 years respectively. Splenectomy was associated with improved chance of CR. Complete recovery without any therapy was seen in 6 patients (median age 4 years). Conclusions: The incidence of ITP was roughly 4/100.000 during the time period studied. Young age, splenectomy and absence of associated conditions was associated with good outcome. No therapy was needed in many young patients.

Original languageEnglish (US)
Pages (from-to)70b
JournalBlood
Volume96
Issue number11 PART II
StatePublished - Dec 1 2000

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ASJC Scopus subject areas

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

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