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Vol. 16, No. 2, 2007
Issue release date: February 2007
Section title: Original Paper
Open Access Gateway
Med Princ Pract 2007;16:100–106
(DOI:10.1159/000098360)

Retrospective Analysis of Patients with Idiopathic Thrombocytopenic Purpura from Eastern Anatolia

Kaya E.a · Erkurt M.A.a · Aydogdu I.a · Kuku I.a · Ozhan O.b · Oner R.I.b · Ulutas O.b
Departments of aHematology and bInternal Medicine, Faculty of Medicine, Inonu University, Malatya, Turkey
email Corresponding Author

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.

© 2007 S. Karger AG, Basel


  

Key Words

  • Idiopathic thrombocytopenic purpura
  • Corticosteroid
  • Splenectomy

References

  1. The American Society of Hematology ITP Practice Guideline Panel: Diagnosis and treatment of idiopathic thrombocytopenic purpura: recommendations of the American Society of Hematology. Ann Intern Med 1997;126:319–326.
  2. Woods VL Jr, Kurata Y, Montgomery RR, Tani P, Mason D, Oh EH, McMillan R: Autoantibodies against platelet glycoprotein Ib and IIb/IIIa complex in patients with chronic immune thrombocytopenic purpura. Blood 1984;64:156–160.
  3. Ballem PJ, Segal GM, Stratton JR, Gernsheimer T, Adamson JW, Slichter SJ: Mechanism of thrombocytopenia in chronic autoimmune thrombocytopenic purpura: evidence of both impaired platelet production and increased platelet clearance. J Clin Invest 1987;80:33–40.
  4. George JN, Woolf SH, Raskob GE, Wasser JS, Aledort LM, Ballem PJ, Blanchette VS, Bussel JB, Cines DB, Kelton JG, Lichtin AE, McMillan R, Okerbloom JA, Regan DH, Warrier I: Idiopathic thrombocytopenic purpura: a practice guideline developed by explicit methods for the American Society of Hematology. Blood 1996;88:3–40.
  5. Frederiksen H, Schmidt K: The incidence of idiopathic thrombocytopenic purpura in adults increases with age. Blood 1999;94:909–913.
  6. Stasi R, Stipa E, Masi M, Cecconi M, Scimo MT, Oliva F, Sciarra A, Perrotti AP, Adomo G, Amadori S, Papa G: Long-term observation of 208 adults with chronic idiopathic thrombocytopenic purpura. Am J Med 1995;98:436–442.
  7. Mazzucconi MG, Arista MC, Peraino M, Chistolini A, Felici C, Francavilla V, Macale E, Conti L, Gandolfo GM: Long-term follow-up of autoimmune thrombocytopenic purpura (ATP) patients submitted to splenectomy. Eur J Haematol 1999;62:219–222.
  8. Karpatkin S: Autoimmune (idiopathic) thrombocytopenic purpura. Lancet 1997;349:1531–1536.
  9. Pamuk GE, Pamuk ON, Baslar Z, Ongoren S, Soysal T, Ferhanoglu B, Aydin Y, Ulku B, Aktuglu G, Akman N: Overview of 321 patients with idiopathic thrombocytopenic purpura: retrospective analysis of the clinical features and response to therapy. Ann Hematol 2002;81:436–440.
  10. Portielje JE, Westendorp RG, Kluin-Nelemans HC, Brand A: Morbidity and mortality in adults with idiopathic thrombocytopenic purpura. Blood 2001;97:2549–2554.
  11. Vianelli N, Valdre L, Fiacchini M, de Vivo A, Gugliotta L, Catani L, Lemoli RM, Poli M, Tura S: Long-term follow-up of idiopathic thrombocytopenic purpura in 310 patients. Haematologica 2001;86:504–509.
  12. Guthrie TH Jr, Brannan DP, Prisant LM: Idiopathic thrombocytopenic purpura in the older adult patient. Am J Med Sci 1988;296:17–21.
  13. Kaufman DW, Kelly JP, Johannes CB, Sandler A, Harmon D, Stolley PD, Shapiro S: Acute thrombocytopenic purpura in relation to the use of drugs. Blood 1993;82:2714–2718.
  14. Leung AY, Chim CS, Kwong YL, Lie AK, Au WY, Liang R: Clinicopathologic and prognostic features of chronic idiopathic thrombocytopenic purpura in adult Chinese patients: an analysis of 220 cases. Ann Hematol 2001;80:384–386.
  15. Cortelazzo S, Finazzi G, Buelli M, Molteni A, Viero P, Barbui T: High risk of severe bleeding in aged patients with chronic idiopathic thrombocytopenic purpura. Blood 1991;77:31–33.
  16. Altintop L, Albayrak D: Oral high-dose methylprednisolone and intravenous immunoglobulin treatments in adult chronic idiopathic thrombocytopenic purpura. Am J Hematol 1997;56:191–192.
  17. Alpdogan O, Budak-Alpdogan T, Ratip S, Firatli-Tuglular T, Tanriverdi S, Karti S, Bayik M, Akoglu T: Efficacy of high-dose methylprednisolone as first-line therapy in adult patients with idiopathic thrombocytopenic purpura. Br J Haematol 1998;103:1061–1063.
  18. Den Ottolander GJ, Gratama JW, de Koning J, Brand A: Long-term follow-up study of 168 patients with immune thrombocytopenia: implications for therapy. Scand J Hematol 1984;32:101–110.
  19. Shashaty GG, Rath CE: Idiopathic thrombocytopenic purpura in the elderly. Am J Med Sci 1978;276:263–267.
  20. George JN, el-Harake MA, Raskob GE: Chronic idiopathic thrombocytopenic purpura. N Engl J Med 1994;331:1207–1211.
  21. Andersen JC: Response of resistant idiopathic thrombocytopenic purpura to pulsed high-dose dexamethasone therapy. N Engl J Med 1994;330:1560–1564.
  22. Godeau B, Lesage S, Divine M, Wirquin V, Farcet JP, Bierling P: Treatment of adult chronic autoimmune thrombocytopenic purpura with repeated high-dose intravenous immunoglobulin. Blood 1993;82:1415–1421.
  23. Kumar S, Diehn FE, Gertz MA, Tefferi A: Splenectomy for immune thrombocytopenic purpura: long-term results and treatment of postsplenectomy relapses. Ann Hematol 2002;81:312–319.
  24. Cooper N, Woloski BM, Fodero EM, Novoa M, Leber M, Beer JH, Bussel JB: Does treatment with intermittent infusions of intravenous anti-D allow a proportion of adults with recently diagnosed immune thrombocytopenic purpura to avoid splenectomy? Blood 2002;99:1922–1927.
  25. Makris M, Greaves M, Winfield DA, Preston EE, Lilleyman JS: Long-term management after splenectomy: lifelong penicillin unproved in trials. BMJ 1994;308:131–132.
  26. Ismet A, Irfan K, Emin K, Ali EM, Ramazan U, Mustafa B, Onur O: Splenectomy results in patients with idiopathic thrombocytopenic purpura: 10 years of experience in Turgut Ozal Medical Center. Clin Lab Haematol 2004;26:211–214.
  27. Andres E, Zimmer J, Noel E, Kattenbach G, Koumarianou A, Maloisel F: Idiopathic thrombocytopenic purpura: a retrospective analysis in 139 patients of influence of age on the response to corticosteroids, splenectomy and danazol. Drugs Aging 2003;20:841–846.
  28. Fabris F, Tassan T, Ramon R, Carraro G, Randi ML, Luzzatto G, Moschino P, Girolami A: Age as the major predictive factor of long-term response to splenectomy in immune thrombocytopenic purpura. Br J Haematol 2001;112:637–640.

  

Author Contacts

Emin Kaya, MD
Department of Hematology, School of Medicine
Turgut Ozal Medical Center, Inonu University
TR–44069 Malatya (Turkey)
Tel. +90 422 341 0660/4202, Fax +90 422 341 0728, E-Mail ekaya@inonu.edu.tr

  

Article Information

Received: April 4, 2006
Revised: May 31, 2006
Number of Print Pages : 7
Number of Figures : 1, Number of Tables : 3, Number of References : 28

  

Publication Details

Medical Principles and Practice (International Journal of the Kuwait University Health Sciences Centre)

Vol. 16, No. 2, Year 2007 (Cover Date: February 2007)

Journal Editor: Owunwanne, A. (Kuwait)
ISSN: 1011–7571 (print), 1423–0151 (Online)

For additional information: http://www.karger.com/MPP


Open Access License / Drug Dosage / Disclaimer

Open Access License: This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial 3.0 Unported license (CC BY-NC) (www.karger.com/OA-license), applicable to the online version of the article only. Distribution permitted for non-commercial purposes only.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

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.

© 2007 S. Karger AG, Basel


  

Author Contacts

Emin Kaya, MD
Department of Hematology, School of Medicine
Turgut Ozal Medical Center, Inonu University
TR–44069 Malatya (Turkey)
Tel. +90 422 341 0660/4202, Fax +90 422 341 0728, E-Mail ekaya@inonu.edu.tr

  

Article Information

Received: April 4, 2006
Revised: May 31, 2006
Number of Print Pages : 7
Number of Figures : 1, Number of Tables : 3, Number of References : 28

  

Publication Details

Medical Principles and Practice (International Journal of the Kuwait University Health Sciences Centre)

Vol. 16, No. 2, Year 2007 (Cover Date: February 2007)

Journal Editor: Owunwanne, A. (Kuwait)
ISSN: 1011–7571 (print), 1423–0151 (Online)

For additional information: http://www.karger.com/MPP


Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: 4/4/2006
Accepted: 5/31/2006
Published online: 2/16/2007
Issue release date: February 2007

Number of Print Pages: 7
Number of Figures: 1
Number of Tables: 3

ISSN: 1011-7571 (Print)
eISSN: 1423-0151 (Online)

For additional information: http://www.karger.com/MPP


Open Access License / Drug Dosage

Open Access License: This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial 3.0 Unported license (CC BY-NC) (www.karger.com/OA-license), applicable to the online version of the article only. Distribution permitted for non-commercial purposes only.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. The American Society of Hematology ITP Practice Guideline Panel: Diagnosis and treatment of idiopathic thrombocytopenic purpura: recommendations of the American Society of Hematology. Ann Intern Med 1997;126:319–326.
  2. Woods VL Jr, Kurata Y, Montgomery RR, Tani P, Mason D, Oh EH, McMillan R: Autoantibodies against platelet glycoprotein Ib and IIb/IIIa complex in patients with chronic immune thrombocytopenic purpura. Blood 1984;64:156–160.
  3. Ballem PJ, Segal GM, Stratton JR, Gernsheimer T, Adamson JW, Slichter SJ: Mechanism of thrombocytopenia in chronic autoimmune thrombocytopenic purpura: evidence of both impaired platelet production and increased platelet clearance. J Clin Invest 1987;80:33–40.
  4. George JN, Woolf SH, Raskob GE, Wasser JS, Aledort LM, Ballem PJ, Blanchette VS, Bussel JB, Cines DB, Kelton JG, Lichtin AE, McMillan R, Okerbloom JA, Regan DH, Warrier I: Idiopathic thrombocytopenic purpura: a practice guideline developed by explicit methods for the American Society of Hematology. Blood 1996;88:3–40.
  5. Frederiksen H, Schmidt K: The incidence of idiopathic thrombocytopenic purpura in adults increases with age. Blood 1999;94:909–913.
  6. Stasi R, Stipa E, Masi M, Cecconi M, Scimo MT, Oliva F, Sciarra A, Perrotti AP, Adomo G, Amadori S, Papa G: Long-term observation of 208 adults with chronic idiopathic thrombocytopenic purpura. Am J Med 1995;98:436–442.
  7. Mazzucconi MG, Arista MC, Peraino M, Chistolini A, Felici C, Francavilla V, Macale E, Conti L, Gandolfo GM: Long-term follow-up of autoimmune thrombocytopenic purpura (ATP) patients submitted to splenectomy. Eur J Haematol 1999;62:219–222.
  8. Karpatkin S: Autoimmune (idiopathic) thrombocytopenic purpura. Lancet 1997;349:1531–1536.
  9. Pamuk GE, Pamuk ON, Baslar Z, Ongoren S, Soysal T, Ferhanoglu B, Aydin Y, Ulku B, Aktuglu G, Akman N: Overview of 321 patients with idiopathic thrombocytopenic purpura: retrospective analysis of the clinical features and response to therapy. Ann Hematol 2002;81:436–440.
  10. Portielje JE, Westendorp RG, Kluin-Nelemans HC, Brand A: Morbidity and mortality in adults with idiopathic thrombocytopenic purpura. Blood 2001;97:2549–2554.
  11. Vianelli N, Valdre L, Fiacchini M, de Vivo A, Gugliotta L, Catani L, Lemoli RM, Poli M, Tura S: Long-term follow-up of idiopathic thrombocytopenic purpura in 310 patients. Haematologica 2001;86:504–509.
  12. Guthrie TH Jr, Brannan DP, Prisant LM: Idiopathic thrombocytopenic purpura in the older adult patient. Am J Med Sci 1988;296:17–21.
  13. Kaufman DW, Kelly JP, Johannes CB, Sandler A, Harmon D, Stolley PD, Shapiro S: Acute thrombocytopenic purpura in relation to the use of drugs. Blood 1993;82:2714–2718.
  14. Leung AY, Chim CS, Kwong YL, Lie AK, Au WY, Liang R: Clinicopathologic and prognostic features of chronic idiopathic thrombocytopenic purpura in adult Chinese patients: an analysis of 220 cases. Ann Hematol 2001;80:384–386.
  15. Cortelazzo S, Finazzi G, Buelli M, Molteni A, Viero P, Barbui T: High risk of severe bleeding in aged patients with chronic idiopathic thrombocytopenic purpura. Blood 1991;77:31–33.
  16. Altintop L, Albayrak D: Oral high-dose methylprednisolone and intravenous immunoglobulin treatments in adult chronic idiopathic thrombocytopenic purpura. Am J Hematol 1997;56:191–192.
  17. Alpdogan O, Budak-Alpdogan T, Ratip S, Firatli-Tuglular T, Tanriverdi S, Karti S, Bayik M, Akoglu T: Efficacy of high-dose methylprednisolone as first-line therapy in adult patients with idiopathic thrombocytopenic purpura. Br J Haematol 1998;103:1061–1063.
  18. Den Ottolander GJ, Gratama JW, de Koning J, Brand A: Long-term follow-up study of 168 patients with immune thrombocytopenia: implications for therapy. Scand J Hematol 1984;32:101–110.
  19. Shashaty GG, Rath CE: Idiopathic thrombocytopenic purpura in the elderly. Am J Med Sci 1978;276:263–267.
  20. George JN, el-Harake MA, Raskob GE: Chronic idiopathic thrombocytopenic purpura. N Engl J Med 1994;331:1207–1211.
  21. Andersen JC: Response of resistant idiopathic thrombocytopenic purpura to pulsed high-dose dexamethasone therapy. N Engl J Med 1994;330:1560–1564.
  22. Godeau B, Lesage S, Divine M, Wirquin V, Farcet JP, Bierling P: Treatment of adult chronic autoimmune thrombocytopenic purpura with repeated high-dose intravenous immunoglobulin. Blood 1993;82:1415–1421.
  23. Kumar S, Diehn FE, Gertz MA, Tefferi A: Splenectomy for immune thrombocytopenic purpura: long-term results and treatment of postsplenectomy relapses. Ann Hematol 2002;81:312–319.
  24. Cooper N, Woloski BM, Fodero EM, Novoa M, Leber M, Beer JH, Bussel JB: Does treatment with intermittent infusions of intravenous anti-D allow a proportion of adults with recently diagnosed immune thrombocytopenic purpura to avoid splenectomy? Blood 2002;99:1922–1927.
  25. Makris M, Greaves M, Winfield DA, Preston EE, Lilleyman JS: Long-term management after splenectomy: lifelong penicillin unproved in trials. BMJ 1994;308:131–132.
  26. Ismet A, Irfan K, Emin K, Ali EM, Ramazan U, Mustafa B, Onur O: Splenectomy results in patients with idiopathic thrombocytopenic purpura: 10 years of experience in Turgut Ozal Medical Center. Clin Lab Haematol 2004;26:211–214.
  27. Andres E, Zimmer J, Noel E, Kattenbach G, Koumarianou A, Maloisel F: Idiopathic thrombocytopenic purpura: a retrospective analysis in 139 patients of influence of age on the response to corticosteroids, splenectomy and danazol. Drugs Aging 2003;20:841–846.
  28. Fabris F, Tassan T, Ramon R, Carraro G, Randi ML, Luzzatto G, Moschino P, Girolami A: Age as the major predictive factor of long-term response to splenectomy in immune thrombocytopenic purpura. Br J Haematol 2001;112:637–640.