Original Article

: 9
, ,

Idiopathic Thrombocytopenic Purpura in Adults at Srinagarind

Hospital: 9 Years Review
Nattiya Teawtrakul, Chittima Sirijerachai, Kanchana Chansung
Division of hematology, Department of internal medicine, Faculty of Medicine, Khon Kaen University

: idiopathic thrombocytopenic
purpura (ITP)
20-30

:
ITP 15
1 2545 31 2553
: 94 70
( 74) 39
56
55 31 3
multiple logistic regression




adjusted Odds ratio(95% CI)
3.54 (0.5 - 22.2) , 5.13 (0.8-30.1) 2.1 (0.6 - 6.7)

:

ITP

2555; 27(1): 43-8

2555; 27(1)

Background and objective: Idiopathic thrombocytopenic

purpura (ITP) is frequently found in general practice. Most
patients respond to standard treatment. However, there
are about 20-30% of patients become chronic ITP, which
responds poorly to treatment. This study aims to study the
epidemiology and clinical factors to predict clinical course
in adult patients with ITP.
Method: This is a cross- sectional, retrospective study in
patients aged 15 years or older who have been diagnosed
as ITP at Srinagarind hospital between 1st January 2002
to 31st December 2010.
Results: Of 94 patients, 70 patients were female (74%).
Mean age was 39 years. Mean follow up duration was 56
months. Fifty five patients were in complete remission,
thirty one patients with chronic ITP and three patients died.
The analysis of the multiple logistic regression, none of
clinical factors were correlated statistically significantly with
the clinical course. However, the complete response after
first-line treatment, the response after first-line treatment
and female sex may be the factors for predicting clinical
complete remission with the adjusted Odds ratio (95%
CI) of 5.13 (0.8-30.1), 3.54 (0.5 - 22.2) and 2.1 (0.6 - 6.7)
respectively, compare with chronic ITP.
Conclusion: The deep response after first-line treatment
and female sex may potentially be the prognostic factors
predicting clinical course of complete remission in the
long-term follow up in adult patients with idiopathic
thrombocytopenic purpura.
Keywords: idiopathic thrombocytopenic purpura, adult,
clinical prognostic factors

Srinagarind Med J 2012: 27(1): 43-8

Srinagarind Med J 2012: 27(1)

43

idiopathic thrombocytopenic purpura

(ITP)

1.6-3.9 100,000 1-3

4, 5


6-8

20-30
9, 10



11,12

9
1 2545 31 2553

15
American society
of Hematology7

1. (no clinical bleeding)

2. (mild bleeding)

44

2555; 27(1)

Idiopathic Thrombocytopenic Purpura in Adults

3. (moderate bleeding)


4. (severe bleeding)

13
1. (Complete response)

100,000
2. (Response)
30,000

3. (No response)
< 30,000

(Clinical course)
1. (Complete remission)
100,000

2. (Chronic ITP)
100,000
1

3. (Death)

(SD)

Multiple logistic regression univariate

analysis p < 0.20
multivariate analysis
p < 0.05
STATA version 10

Srinagarind Med J 2012: 27(1)

165 71
50 21

94 70 (74.47) 24
( 25.53)
39.91 17.13 ( 59.57)

( 21.27) (
15.95)
2 (2.12)
23758.51 21283.04

89
51.69
30.34
17.98
12 ( 13.48)
1 ( 34.83)


50 ( 56.17)
17 ( 19.10)
12 ( 13.48)
7 ( 7.86)
9

56 55
55 ( 61.80) 31 (
34.83) 3 ( 3.37)
( 1)
univariate analysis

(p-value = 0.002
p-value = 0.012 )

2555; 27(1)

Nattiya Teawtrakul, et al.

16
6 ( 37.5)
3 ( 18.75)
46
32 ( 69.56)
14 (
30.43)
12
(continuing complete response)

(p-value = 0.07 p-value = 0.10 )

univariate analysis

( 2)
multiple logistic
regression

(p-value = 0.18 p-value = 0.4
)
adjusted Odds ratio
3.54 (95% CI 0.56 - 22.28)

adjusted Odds ratio

5.13 (95% CI 0.87-30.19)

adjusted Odds
ratio 2.10 (95% CI 0.65 - 6.79)

multiple logistic regression

( 3)

Srinagarind Med J 2012: 27(1)

45

Idiopathic Thrombocytopenic Purpura in Adults

Table 1 Demographic and clinical characteristic data of patients with immune thrombocytopenic purpura.
Characteristics
Patients
Age, year (at enrollment) (N=94)
Mean (SD)
39.91 (17.13)
Sex, (%) (N=94)
Female
70 (74.47)
Male
24 (25.53)
Follow-up duration, months (N=94)
Mean (SD)
56(55.99)
Clinical presentation, (%) (N=94)
No clinical bleeding
20 (21.27)
Mild bleeding
56 (59.57)
Moderate bleeding
15 (15.95)
Severe bleeding
2 (2.12)
Initial Complete blood count, Mean (SD) (N=94)
WBC (cells/L)
10371.94 (4583.06)
Hemoglobin (g/dL)
11.96 (2.00)
Platelet count (cells/L)
23758.51 (21283.04)
Response to first-line treatment, (%) (N=89)
No response (platelet < 30 x 109/L)
16 (17.98)
9
Response (platelet > 30 x 10 /L)
27 (30.34)
9
Complete response (platelet > 100 x 10 /L)
46 (51.69)
Splenectomy, (%) (N=89)
No
77 (86.52)
Yes
12 (13.48)
Bone marrow examination, (%) (N=89)
No
58 (65.16)
Yes
31 (34.83)
Second-line treatment, (%) (N=89)
No treatment
50 (56.17)
High dose steroid
7 (7.86)
Immunosuppressive drug
17 (19.10)
Intravenous immunoglobulin
1(1.12)
Splenectomy
12 (13.48)
Other (FFP)
2 (2.24)
Clinical course, (%) (N=89)
Complete response
55 (61.80)
Chronic ITP
31 (34.83)
Death
3 (3.37)
46

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Nattiya Teawtrakul, et al.

Table 2 Univariate analysis of clinical predictive factors for chronic ITP status.
Variable
1. Splenectomy
2. Response to first-line treatment
3. Initial platelet count
4. Sex
5. Clinical presentation
6. Age

P-value
0.002
0.012
0.076
0.101
0.227
0.842

Table 3 Multivariate logistic regression of clinical course and response after 1st line treatment in patient with ITP.
Clinical course and variables
Adjusted odds ratio
95% CI
P-value
Chronic ITP (N=31)
Referent
1.00
Response after 1st line treatment
st
Referent
1.00
Complete response after 1 line treatment
Referent
Sex
1.00
Referent
Initial platelet count
1.00
Referent
Splenectomy
1.00
Complete remission (N=55)
0.56 - 22.28
0.50
3.54
Response after 1st line treatment
0.87- 30.19
0.18
5.13
Complete response after 1st line treatment
0.65 - 6.79
0.40
Sex (female)
2.10
0.99-1.00
0.30
Initial platelet count
0.99
0
Splenectomy
1.46e+08

74.5
Abrahamson 2
(4.2 100,000
3.2 100,000 )
40
2, 14
57 55

(39 46 )
15 univariate
analysis

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multiple logistic regression

Srinagarind Med J 2012: 27(1)

47

3.54 5.13

(p-value = 0.225)

2.10 (p-value = 0.4)

Idiopathic Thrombocytopenic Purpura in Adults

1. Frederiksen H, Schmidt K. The incidence of idiopathic

thrombocytopenic purpura in adults increases with age.
Blood. 1999; 94:909-13.
2. Abrahamson PE, Hall SA, Feudjo-Tepie M, Mitrani-Gold
FS, Logie J. The incidence of idiopathic thrombocytopenic
purpura among adults: a population-based study and
literature review. Eur J Haematol 2009; 83:83-9.
3. Neylon AJ, Saunders PWG, Howard MR, Proctor SJ, Taylor
PRA. Clinically significant newly presenting autoimmune
thrombocytopenic purpura in adults: a prospective study of
a population-based cohort of 245 patients. Br J Haematol
2003; 122:966-74.
4. Guidelines for the investigation and management of
idiopathic thrombocytopenic purpura in adults, children and
in pregnancy. Br J Haematol 2003; 120:574-96.

5. George JN, Woolf SH, Raskob GE, Wasser JS, Aledort LM,
Ballem PJ, et al. Idiopathic thrombocytopenic purpura:
a practice guideline developed by explicit methods for the
American Society of Hematology. Blood 1996; 88:3-40.
6. Han JJ, Baek SK, Lee JJ, Kim SY, Cho KS, Yoon HJ.
Long-term outcomes of a 5-year follow up of patients with
immune thrombocytopenic purpura after splenectomy.
Korean J Hematol 2010; 45:197-204.
7. Neunert C, Lim W, Crowther M, Cohen A, Solberg L Jr,
Crowther MA, et al. The American Society of Hematology
2011 evidence-based practice guideline for immune
thrombocytopenia. Blood 2011; 117:4190-207.
8. Stasi R, Stipa E, Masi M, Cecconi M, Scim MT, Oliva F, et al.
Long-term observation of 208 adults with chronic idiopathic
thrombocytopenic purpura. Am J Med 1995; 98:436-42.
9. Fogarty PF. Chronic immune thrombocytopenia in adults:
epidemiology and clinical presentation. Hematol Oncol Clin
North Am 2009; 23:1213-21.
10. Segal JB, Powe NR. Prevalence of immune thrombocytopenia:
analyses of administrative data. J Thromb Haemost 2006;
4:2377-83.
11. Wanachiwanawin W, Visudhiphan S, Pinankijagum A,
Vatanavicharn S. Therapy of chronic idiopathic
thrombocytopenic purpura in adults: experiences from
Thailand. Southeast Asian J Trop Med Public Health 1993;
24 Suppl 1:71-5.
12. Wanachiwanawin W, Visudhiphan S, Piankijagum A,
Vatanavicharn S. Serious complications following treatment
of chronic idiopathic thrombocytopenic purpura. Postgrad
Med J 1988; 64:426-30.
13. Rodeghiero F, Stasi R, Gernsheimer T, Michel M, Provan D,
Arnold DM, et al. Standardization of terminology, definitions
and outcome criteria in immune thrombocytopenic purpura
of adults and children: report from an international working
group. Blood 2009; 113:2386-93.
14. Rodeghiero F, Besalduch J, Michel M, Provan D, Grotzinger K,
Thompson G. Treatment practices in adults with chronic
immune thrombocytopenia-a European perspective. Eur J
Haematol 2010; 84:160-8.
15. Schoonen WM, Kucera G, Coalson J, Li L, Rutstein M, Mowat F,
et al. Epidemiology of immune thrombocytopenic purpura in
General Practice Research Database. Br J Haematol 2009;
145:235-44.

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