Contributions
Abstract: P16
Type: Poster presentation
Presentation during EHA Scientific Conference on Bleeding Disorders:
On Friday, September 16, 2016 from 14:00 - 15:30
Location: Cristal + Coral
Background
Idiopathic thrombocytopenic purpura (ITP) is a heterogeneous clinical disorder characterized by immune-mediated platelet destruction. 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.
Methods
We investigated 150 Egyptian patients with ITP who were registered in clinical hematology unit, Cairo university, Egypt during period between 2008 and early 2016 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.
Results
We had investigated 150 ITP patients, Female (n;123) 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 150 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 1st line of therapy were given a 2nd line of therapy and the details of it were as follow (splenectomy was done in 16,1 % and CR was 3%, 20% 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% )
Conclusion
Most ITP patients were females and investigating 2ry causes of ITP cases even there is no clear symptoms of the 2ry cause is very important. Using another agents as 2nd line therapy rather than splenectomy they proved its efficacy.
References
1. El Demerdash, D.M.; El Hussieny, N.M.; Mattar, M.M.
2. Neunert C et al., Blood. 2011;117:4190
3. Arnold D & Kelton J., seminar hematol. 2007;44:S12
4. Ghanima W et al; Blood 2012; 120: 960
Abstract: P16
Type: Poster presentation
Presentation during EHA Scientific Conference on Bleeding Disorders:
On Friday, September 16, 2016 from 14:00 - 15:30
Location: Cristal + Coral
Background
Idiopathic thrombocytopenic purpura (ITP) is a heterogeneous clinical disorder characterized by immune-mediated platelet destruction. 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.
Methods
We investigated 150 Egyptian patients with ITP who were registered in clinical hematology unit, Cairo university, Egypt during period between 2008 and early 2016 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.
Results
We had investigated 150 ITP patients, Female (n;123) 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 150 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 1st line of therapy were given a 2nd line of therapy and the details of it were as follow (splenectomy was done in 16,1 % and CR was 3%, 20% 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% )
Conclusion
Most ITP patients were females and investigating 2ry causes of ITP cases even there is no clear symptoms of the 2ry cause is very important. Using another agents as 2nd line therapy rather than splenectomy they proved its efficacy.
References
1. El Demerdash, D.M.; El Hussieny, N.M.; Mattar, M.M.
2. Neunert C et al., Blood. 2011;117:4190
3. Arnold D & Kelton J., seminar hematol. 2007;44:S12
4. Ghanima W et al; Blood 2012; 120: 960