title: Clinically significant newly presenting autoimmune thrombocytopenic purpura in adults: a prospective study of a population-based cohort of 245 patients.
abstract: The true incidence and prognosis of autoimmune thrombocytopenic purpura (ITP) in adults is unknown. We present the results of a prospective study in a population-based cohort of newly presenting adults (> or = 16 years) with ITP and platelet count of < 50 x 109/l, which took place between 1 January 1993 and 31 December 1999 in the former Northern Health Region in the UK (population 3.08 million). A total of 245 cases were confirmed by bone marrow examination with a median follow-up of 60 months (range 6-78 months). There were 134 females/111 males (1.2:1). Overall incidence was 1.6 per 105 per annum. Absolute incidence was similar for both sexes, with highest age-specific incidence in those aged > 60 years. Thirty patients (12%) presented with frank bleeding, and 28% were asymptomatic. Forty-five patients (18%) received no treatment, and 135 (55%) received first-line treatment only. Thirty patients (12%) underwent splenectomy. There were four deaths (1.6%) from bleeding and/or the complications of therapy in this cohort, but only one was in the acute phase of the illness. The majority of patients (155 out of 245) achieved remission (platelet count > 100 x 109/l), with a further 59 (24%) in partial remission with no symptoms (platelet count 30-100 x 109/l). This population-based study suggests that the traditional view of adult ITP as being a predominantly chronic disease that preferentially affects females needs to be modified.
authors.affiliation: University Department of Haematology, Royal Victoria Infirmary, Newcastle upon Tyne, and York District General Hospital, York, UK.
authors.forename: Annette J
authors.initials: AJ
authors.lastname: Neylon
authors.forename: Peter W G
authors.initials: PW
authors.lastname: Saunders
authors.forename: Martin R
authors.initials: MR
authors.lastname: Howard
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Proctor
authors.forename: Penelope R A
authors.initials: PR
authors.lastname: Taylor
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D004739:England / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D015994:Incidence; D007239:Infections / Q000150:complications; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011379:Prognosis; D011446:Prospective Studies; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000150:complications / Q000453:epidemiology* / Q000628:therapy; D012075:Remission, Spontaneous; D017678:Sex Distribution; D013156:Splenectomy; D016896:Treatment Outcome