Outcomes in primary immune thrombocytopenia (ITP): a retrospective audit on a single tertiary referral centre

Abstract

Aims To review the presentation and outcome of primary immune thrombocytopenia (ITP) using recent international working group guidelines.1 Methods 422 possible ITP cases (1/1/2005-1/6/2010) were examined at St George Hospital: medical records, laboratory databases. Results 67 primary ITP (54 new diagnoses, 13 relapsed): median age 57.8 years, platelet count 34 × 109/L, females 58%. 48% initial platelet count <30 × 109/L. 24 month platelet counts: <30 × 10 /L in 9%, ≥30 × 109/L in 91% and ≥100 × 109/L in 35%. 6 month CR (complete response: platelet count ≥100 × 109/L, no bleeding) 25%, and R (response: platelet count ≥30 × 109/L, double baseline, no bleeding) 36%. 25 episodes grade III/IV bleeding, 19/67 patients. 54 newly diagnosed primary ITP: 16 treatment free from presentation, median follow-up 13.7 months. 23 required steroids, median duration 53 days. Median time to second-line therapies 49 days. 11 of 17 required second-line within 3 months of presentation. 24 intial platelet count <30 × 109/L required more treatments (2.6 ± 0.7 versus 0.4 ± 0.4, p = 0.05). Discussion Patients not requiring treatment at presentation usually remain treatment free. Conversely, most patients requiring additional therapies begin second-line within 3 months of presentation. To review the presentation and outcome of primary immune thrombocytopenia (ITP) using recent international working group guidelines.1 422 possible ITP cases (1/1/2005-1/6/2010) were examined at St George Hospital: medical records, laboratory databases. 67 primary ITP (54 new diagnoses, 13 relapsed): median age 57.8 years, platelet count 34 × 109/L, females 58%. 48% initial platelet count <30 × 109/L. 24 month platelet counts: <30 × 10 /L in 9%, ≥30 × 109/L in 91% and ≥100 × 109/L in 35%. 6 month CR (complete response: platelet count ≥100 × 109/L, no bleeding) 25%, and R (response: platelet count ≥30 × 109/L, double baseline, no bleeding) 36%. 25 episodes grade III/IV bleeding, 19/67 patients. 54 newly diagnosed primary ITP: 16 treatment free from presentation, median follow-up 13.7 months. 23 required steroids, median duration 53 days. Median time to second-line therapies 49 days. 11 of 17 required second-line within 3 months of presentation. 24 intial platelet count <30 × 109/L required more treatments (2.6 ± 0.7 versus 0.4 ± 0.4, p = 0.05). Patients not requiring treatment at presentation usually remain treatment free. Conversely, most patients requiring additional therapies begin second-line within 3 months of presentation.