Clinical analysis of 123 cases of primary immune thrombocytopenia in adults

Abstract

Objective To investigate the clinical characteristics of primary immune thrombocytopenia (ITP) in adults and to summarize the experience in order to improve the clinical diagnosis and treatment of ITP. Methods from February 2008 to June 2014, a total of 123 cases of adult patients with ITP in Taizhou People's Hospital affiliated to Yangzhou University were collected into this study, as the research object. The clinical data, clinical manifestation, laboratory examination, treatment and therapeutic effect of 123 cases of adult ITP were retrospectively analyzed. The study protocol was approved by the Ethical Review Board of Investigation in Human at Taizhou People's Hospital affiliated to Yangzhou University. Informed consent was obtained from all participants. All adult ITP patients peripheral blood and bone marrow like, immunological indexes were detected; and the adult ITP patients in different age patients with male and female incidence ratio were statistically analyzed. Results ①The ratio of male to female was 1∶9.5 in patients with ITP from 21to 40 years old, and the ratio of male to female was 1∶2.3 in patients with ITP from 41 to 60 years old There was significant difference between incidence rates of male and female in two age periods(χ2=4.474, P=0.034). ②19 out of 123 cases of adult ITP patients had a clear incentive, and incentives were all upper respiratory tract infection. Adult ITP patients's bleeding parts from high frequency to low were as follows: the skin and mucosa, menorrhagia, urinary tract and digestive tract and intracranial hemorrhage .The complications of adult ITP patients with pulmonary infection were 4 cases, and femoral head necrosis were 2 cases. The occurrence of steroid diabetes were 12 cases. Low potassium were 8 cases. Before treatment, the adult ITP platelet count in patients was (14.6±12.2)×109/L. The number of bone marrow megakaryocytes were increased in 75 cases (61%), and the rest 48 cases (39%) were normal. All the patients had megakaryocyte maturation disorder. ③The follow-up time was 3 months to 32 years, and the median time was 42 months. After first-line treatment of glucocorticoid treatment scheme, 69 cases of patients (56.1%) obtained complete response (CR), partial response (PR) were 29 cases (23.6%) and non-response (NR) were 25 cases (20.3%). After cessation of glucocorticoids, platelet count of 69 cases obtained CR maintained at a normal level, and platelet count of 29 cases obtained PR were more than 30×109/L, without obvious bleeding manifestations. 25 cases of NR patients were treated with second-line therapy. second-line therapy respectively were vincristine, cyclosporine A (CSA) and rituximab and splenectomy, and treatment efficiency were 44.4%. 50.0%, 80.0% and 85.7%, respectively. Conclusion Adult ITP treatment should pay attention to the principle of individual treatment, so that the blood platelet count increased to a safe level, and over treatment should be avoided as far as possible. Key words: Thrombocytopenia; Adult; Glucocorticoids