A CLINICAL STUDY OF PATIENTS WITH IDIOPATHIC THROMBOCYTOPENIC PURPURA


Karthik Rao, Gurukanth Rao, Navin Patil, Balaji Ommurugan, N R Rao, Jayaprakash Rao, Satish Nayak

Abstract


OBJECTIVE

 To study the incidence, age and sex distribution among adults, various modes of presentation, correlation between thrombocytopenia and bleeding manifestations and various modalities of treatment of Idiopathic Thrombocytopenic Purpura in a tertiary care hospital in India.

MATERIALS AND METHODS

Prospective study consisting of 4o cases of ITP admitted to Kasturba Medical College Hospital, Manipal from November 2005 to March 2007. Patients above 14 years of age admitted with thrombocytopenia in this institution were screened based on detailed clinical history, physical examination and laboratory investigations.

RESULTS

The maximum incidence was in the 3 rd decade of life accounting for 27.5% of the patients. Ratio of male to female was 1:1.9 with female preponderance. Females in 3 rd decade had maximum incidence while males in 4th decade have maximum incidence. Majority 12 (85.71%) of male patients and 15(57.69%) of female patients  developed purpura during the course of disease. The mean count was 17.8X109/L with range between 2.0 X109/L to 76 X109/L. Cutaneous bleeding spots were found to be assosiated with counts above 25000X109/L and hematuria with lowest counts around 4000 X109/L. 20 (50%) of the above 40 patients responded to corticposteroids alone and did not have any further relapse. Among the remaining patients 3 (7.5%) had a relapse of symptoms within next 6 months and responded to repeat prednisolone started at 1mg/kg. 2 (5%) patients were given steroids tapering dose with IV Immune globulins for initial 5 days as therapy to which they responded.

CONCLUSION

Idiopathic thrombocytopenia is 1.9 times more common in females than males. Most common presentation is bleeding spots over body. Bleeding manifestations are more common with thrombocytopenia less than 30000/mm3. Corticosteroids are the mainstay in treatment. Complete remission is seen in up to 57.5% of the patients. Splenectomy is the second modality of treatment in ITP. Complete and sustained remission is seen 75% of patients.

 

 


Keywords


Idiopathic Thrombocytopenic Purpura, Splenectomy, Steroids, Purpura

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References


Rao VK. ITP: hematology’s Cosette from Les Misérables. blood. 2013 Mar 14;121(11):1928-30.

Segal JB, Powe NR. Prevalence of immune thrombocytopenia: analyses of administrative data. Journal of Thrombosis and Haemostasis. 2006 Nov 1;4(11):2377-83.

Harrison P. Platelet alpha-granular fibrinogen. Platelets. 1992 Jan 1;3(1):1-0.

Harrison P. Platelet alpha-granular fibrinogen. Platelets. 1992 Jan 1;3(1):1-0.

Leung LL. Role of thrombospondin in platelet aggregation. Journal of Clinical Investigation. 1984 Nov;74(5):1764.

Roth GJ. Developing relationships: arterial platelet adhesion, glycoprotein Ib, and leucine-rich glycoproteins. Blood. 1991;77(1):5-19.

Chang M, Nakagawa PA, Williams SA, Schwartz MR, Imfeld KL, Buzby JS, Nugent DJ. Immune thrombocytopenic purpura (ITP) plasma and purified ITP monoclonal autoantibodies inhibit megakaryocytopoiesis in vitro. Blood. 2003 Aug 1;102(3):887-95.

McMillan R, Wang L, Tomer A, Nichol J, Pistillo J. Suppression of in vitro megakaryocyte production by antiplatelet autoantibodies from adult patients with chronic ITP. Blood. 2004 Feb 15;103(4):1364-9.

Nomura S, Dan K, Hotta T, Fujimura K, Ikeda Y. Effects of pegylated recombinant human megakaryocyte growth and development factor in patients with idiopathic thrombocytopenic purpura. Blood. 2002 Jul 15;100(2):728-30.

Bussel JB, Kuter DJ, George JN, Aledort LM, Lichtin AE, Lyons RM, Nieva J, Wasser JS, Bourgeois E, Kappers-Klunne M, LeFrere F. Long-term dosing of AMG 531 is effective and well tolerated in thrombocytopenic patients with immune thrombocytopenic purpura. Blood. 2005 Nov 16;106(11):220-.

McMillan R, Wang L, Tani P. Prospective evaluation of the immunobead assay for the diagnosis of adult chronic immune thrombocytopenic purpura (ITP). Journal of Thrombosis and Haemostasis. 2003 Mar 1;1(3):485-91.

Berchtold P, Beardsley D, Fujisawa K, Kaplan C, Lipp E, Morell‐Kopp MC, Kiefel V, McMillan R, Imbach P. International study to compare antigen‐specific methods used for the measurement of antiplatelet autoantibodies. British journal of haematology. 1997 Mar 1;96(3):477-83.

Fabris F, Scandellari R, Ruzzon E, Randi ML, Luzzatto G, Girolami A. Platelet-associated autoantibodies as detected by a solid-phase modified antigen capture ELISA test (MACE) are a useful prognostic factor in idiopathic thrombocytopenic purpura. Blood. 2004 Jun 15;103(12):4562-4.

Webster ML, Sayeh E, Crow M, Chen P, Nieswandt B, Freedman J, Ni H. Relative efficacy of intravenous immunoglobulin G in ameliorating thrombocytopenia induced by antiplatelet GPIIbIIIa versus GPIbα antibodies. Blood. 2006 Aug 1;108(3):943-6.

Samuelsson A, Towers TL, Ravetch JV. Anti-inflammatory activity of IVIG mediated through the inhibitory Fc receptor. Science. 2001 Jan 19;291(5503):484-6.

Lusher JM, Zuelzer WW. Idiopathic thrombocytopenic purpura in childhood. The Journal of pediatrics. 1966 Jun 1;68(6):971-9.

Kurtzberg J, Stockman 3rd JA. Idiopathic autoimmune thrombocytopenic purpura. Advances in pediatrics. 1993 Dec; 41:111-34.

McWilliams NB, Maurer HM. Acute idiopathic thrombocytopenic purpura in children. American journal of hematology. 1979 Sep 1;7(1):87-96.

Doan CA, Bouroncle BA, Wiseman BK. Idiopathic and secondary thrombocytopenic purpura: clinical study and evaluation of 381 cases over a period of 28 years. Annals of Internal Medicine. 1960 Nov 1;53(5):861-76.

Kelton JG. Vaccination-associated relapse of immune thrombocytopenia. Jama. 1981 Jan 23;245(4):369-71.

Brown D N, Eliott H E. The result of splenectomy in thrombocytopenic purpura. Jama. 1986: 1781.

Portielje JE, Westendorp RG, Kluin-Nelemans HC, Brand A. Morbidity and mortality in adults with idiopathic thrombocytopenic purpura. Blood. 2001 May 1;97(9):2549-54.

Branehög I, Kutti J, Weinfeld A. Platelet survival and platelet production in idiopathic thrombocytopenic purpura (ITP). British journal of haematology. 1974 May 1;27(1):127-43.

Wong GC, Lee LH. A study of idiopathic thrombocytopenic purpura (ITP) patients over a ten-year period. Annals-academy of medicine Singapore. 1998 Nov; 27:789-93.

DiFino SM, Lachant NA, Kirshner JJ, Gottlieb AJ. Adult idiopathic thrombocytopenic purpura: clinical findings and response to therapy. The American journal of medicine. 1980 Sep 1;69(3):430-42.

Lacey JV, Penner JA. Management of idiopathic thrombocytopenic purpura in the adult. InSeminars in thrombosis and hemostasis. 1977;3(3):160-174.

Laros RK, Penner JA. Refractory thrombocytopenic purpura treated successfully with cyclophosphamide. JAMA. 1971 Jan 18;215(3):445-9.

Caplan SN, Berkman EM. Immunosuppressive therapy of idiopathic thrombocytopenic purpura. Medical Clinics of North America. 1976 Sep 1;60(5):971-86.




About this article

Title

A CLINICAL STUDY OF PATIENTS WITH IDIOPATHIC THROMBOCYTOPENIC PURPURA

Keywords

Idiopathic Thrombocytopenic Purpura, Splenectomy, Steroids, Purpura

DOI

10.22159/ajpcr.2017.v10i7.18775

Date

01-07-2017

Additional Links

Manuscript Submission

Journal

Asian Journal of Pharmaceutical and Clinical Research
Vol 10 Issue 7 July 2017 Page: 373-377

Print ISSN

0974-2441

Online ISSN

2455-3891

Authors & Affiliations

Karthik Rao
ASSISTANT PROFESSOR, DEPARTMENT OF INTERNAL MEDICINE, KASTURBA MEDICAL COLLEGE, MANIPAL UNIVERSITY, MANIPAL
India

Gurukanth Rao
CONSULTANT PHYSICIAN, ASTER CLINIC, DUBAI.
India

Navin Patil
ASSISTANT PROFESSOR, DEPARTMENT OF PHARMACOLOGY, KASTURBA MEDICAL COLLEGE, MANIPAL UNIVERSITY, MANIPAL
India

Balaji Ommurugan
Post graduate , Department of Pharmacology, Kasturba Medical college , Manipal university , Manipal.
India

N R Rao
CONSULTANT, ANUGRAHA MEDICAL CENTER, UDUPI.
India

Jayaprakash Rao
ASSOCIATE PROFESSOR, DEPARTMENT OF MEDICINE, KMC, MANIPAL.
India

Satish Nayak
SENIOR RESIDENT, DEPARTMENT OF GASTROENTEROLOGY, APPOLO, CHENNAI
India


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