Treatment of patients diagnosed with primary immune thrombocytopenia at the Hematology Department of the University Medical Centre Ljubljana

Abstract

Background: Primary immune thrombocytopenia (ITP) is an autoimmune disorder resulting from antibody- and T-cell-mediated destruction of the platelets and suppression of platelet production in the bone marrow. According to the International Consensus report, in order to be diagnosed with ITP, patient is required to have isolated thrombocytopenia with a platelet count below 100 × 109/L, with no other obvious cause for this condition and no other disease that could cause secondary immune thrombocytopenia. Methods: We retrospectively analysed patients who were treated de novo for ITP at the Departement of Hematology of the University Medical Centre Ljubljana (UMC) between the period from 1 January 2008 to 31 December 2012. We excluded those who did not meet the criteria for diagnosis of ITP. Afterwards we analyzed the type and response to treatment and the incidence of bleeding. Splenecomised patients were analysed separately. Results: In the four-year period we treated 153 patients diagnosed with ITP. 113/153 were included in the study, while 40/153 (26 %) were excluded. Bleeding incidents were recorded in 47/113 (41.5 %), but none of them were life threatening or fatal. 14/113 (12.4 %) were treated by splenectomy. Conclusions: Since ITP is a diagnosis of exclusion, many patient do not meet all the criteria for firm diagnosis. Considering low platelet counts, life threathening or even fatal bleedings are rare. Corticosteroids are standard first-line treatment. Nevertheless, many patients do not need any treatment at the time of diagnosis. At our centre splenectomy is often used as a second line treatment. In patients with refractory ITP or those who are not good candidates for splenectomy, we also use thrombopoetin receptors agonists or rituximab.