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Clinically significant acute thrombocytopenic purpura in adults: The Northern Region experience

Lookup NU author(s): Dr Annette Neylon, Professor Stephen Proctor, Dr Peter Saunders, Dr Penelope Taylor


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Since 1 January 1993, Consultant Haematologists in the Northern Health Region of England (pop. 3.08 million) have registered all new cases of ITP centrally. Patients aged <16 years, those with a platelet count > 50 x 109/1 and pregnant women were excluded. Confirmation of the diagnosis by bone marrow examination was mandatory for inclusion in the study. 248 consecutive unselected patients, 150 f, 98 m (ratio 1.53 : 1) were assessed, median age 57 years (range 16-91), median platelet count 10 (range 0 - 49) with the majority having Hb and WCC in the normal range (Hb median 13.1, range 1.3 to 19.1 ; WCC median 7.4, range 2.9 to 52). Of 248 patients, 16% were asymptomatic, 68.7% had purpura, and 15.3% had a bleeding diathesis. There was no difference between genders in mode of presentation. 10% of the patients had concomitant malignancy (with 4% haematopoietic), 2.5% had inflammatory bowel disease and 10% were related to drugs, over half being attributed to quinine (median age in patients due to quinine was 69 (range 45 -82)). The median age of patients documented to have preceding viral symptoms was 23 years (range 16-61) and in total there was a documented viral illness in 12% of the overall population. Treatment was initially steroids, followed by IgG with splenectomy as 3rd line, though physicians could treat as they wished. Presenting platelet count < 5 (32% of total) -84% received steroid alone of whom 65% required no further treatment. 14% proceeded to splenectomy Presenting platelet count 6-10 (20%) -78% had steroid alone, with 42% requiring no further treatment. 16% proceeded to splenectomy. Presenting count 11 -20 (20%) -84% received steroids and 56% required no further treatment. 16% proceeded to splenectomy. Presenting count > 20 (28%) -50% received treatment, only 4% required splenectomy. There was only 1 death in the acute phase (from GI haemorrhage) and the majority of patients required no treatment other than steroids. Only 11% proceeded to splenectomy. Population based data demonstrates profound differences in ITP in adults from published studies from single institutions.

Publication metadata

Author(s): Neylon A, Howard M, Proctor SJ, Saunders PWG, Taylor PRA

Publication type: Article

Publication status: Published

Journal: Blood

Year: 2000

Volume: 96

Issue: 11

Pages: 68B-68B

ISSN (print): 0006-4971

ISSN (electronic): 1528-0020

Notes: Conference: Annual meeting of the American Society of Hematologists. Abstract 3968