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Idiopathic thrombocytopenic purpura (ITP) is a heterogeneous clinical disorder characterized by immune-mediated platelet destruction, it may present both as an acute, self-limiting condition and as a recurrent (chronic) form. The clinical differences between newly diagnosed and chronic ITP suggest the existence of different pathophysiological mechanisms in the two forms. 

We aimed to study the clinical, laboratory parameters as well as response to therapy in Egyptian adults with ITP.

 

We investigated 108 Egyptian patients with immune thrombocytopenia who were registered in clinical hematology unit, internal medicine department, Cairo university, Egypt during period between 2013 and early 2015 through history, physical examination, laboratory tests including CBC, reticulocyte ounts, ESR, PTT, PT,  virology markers;  CMV IgM, EBV IgM, HCVAb, HBsAg and HBcAb, ANA, Lupus anticoagulant, anticardiolipine, H pylori antigen in stool and TSH and response to therapy including response to rituximab and thrompopoietin agents recently introduced as line of therapy in our center.

We had investigated 108 ITP patients, Female (n;89) were 82% while male were 18%, The median age  at the time of diagnosis was 30 years and its range was (14–70) years, Duration of disease ranged between (3 months-21 years) where the median duration was 2.5 years, 45% were newly diagnosed, 44% had chronic ITP and 10% had persistent ITP.  Bleeding symptoms were present in 88% (the frequency of various bleeding symptoms were as follows: cutaneous bleeding 79%; gingival hemorrhage 33%; epistaxis 30.5 %; vaginal bleeding 27.7%; melena 3.7%; hematuria 4.6%; 1.8% fresh bleeding per rectum and  post-partum hemorrhage 0.9%),  The median platelet count at the time of diagnosis was 15,000/ mm3 where  38.8% patients had a platelet count <10,000/mm3, ANA was positive in 13.8%, and anti-DNA was positive in 1.8% of ITP patients who had symptoms and signs fulfilling criteria to diagnose SLE.  APL antibodies were positive in 4.8 % who also had history either of thrombosis or abortion. HBsAg was negative  in all studied patients where anti-HCV antibody  was positive  in 13.8% of patients, also 15.7 % of our patients  had positive H pylori antigen in stool with silent gastritis,  2.7% had positive  anti EBV IgM with high titer and none of studied patients had positive anti CMV IgM. Regarding the thyroid functions 6.4 % had abnormal functions where 3.7% of ITP patients had overt hypothyroidism. Also the onset of disease was related to pregnancy in 12% of ITP patients. Regarding Treatment and follow-up; There was an indication for treatment in 96% of patients,   Of the 104 ITP patients who were given first-line therapy (corticosteroid 1mg/kg/day PO), there was complete response (CR) in 40.3% and 59.7 %  patients were nonresponsive to therapy. Patients who had failure of response to  1^st line of therapy were  given a 2^nd line of therapy and the  details of it were as follow (splenectomy was  done in 16,1 % and CR was 3%, 14% received rituximab and CR was 60%, 3 % received (TPO) agonist; Eltombopag and CR was 100%, 45% received combined azathioprine and steroid therapy and CR was 64%, 4.8 % received triple therapy in form of steroid, azathioprine and danazole where CR was 66%, 8.1% received vincristine and CR was 20% and 5 patients received anti H pylori triple therapy and CR was 20% ) 

Most ITP patients were females and investigating 2ry causes of ITP cases even when there is no clear symptoms of the 2ry cause is very important and may be a rising issues in future. Using another agents as 2^nd line therapy rather than splenectomy they proved its value although it still need more time and number of ITP patients to prove its efficacy that’s why our study still ongoing recruiting more chronic ITP patients to represent our single center Egyptian experience.