title: Chronic ITP: analysis of various factors at presentation which predict failure to first line treatment and their response to second line therapy.
abstract: OBJECTIVE
  To observe the significance of various factors in chronic idiopathic thrombocytopenic purpura (ITP) which predict the response of first line (corticosteroids) and second line therapy (splenectomy) and to evaluate their response to second line therapy.
  
  
  METHODS
  This was a descriptive, prospective study conducted from August 2004 till January 2006. Patients of all age groups and both genders with diagnosis of chronic ITP were included. Treatment protocol and criteria for response assessment was explained.
  
  
  RESULTS
  During 17 months period, 86 patients with chronic ITP were analyzed. Non-responders to first line therapy were 74 patients who ultimately required splenectomy. Complete response (CR) was had in 37 (50.7%) patients, 10 (13.7%) and 27 (36.5%) had partial response (PR) and no response (NR) respectively. Analysis of variables like younger age, sex and low platelet count at presentation failed to show any significant influence on response to first line treatment. However response to splenectomy was found to be higher in patients who had initial complete or partial response with steroids and later relapsed and the platelet count was more than 300x10(9)/L on day 14 of surgery.
  
  
  CONCLUSIONS
  Splenectomy remains the most effective treatment of chronic ITP. No significant factor was identified which predicted initial response to first line treatment. However patients who initially responded to steroids and had platelet counts above 300 X109/L about a fortnight after splenectomy showed promising results post-operatively (p=0.003 and p=0.001).
authors: Department of Pathology and Microbiology, Aga Khan University Hospital, Karachi.
authors: Naveen Naz
authors: NN
authors: Syed
authors: Salman Naseem
authors: SN
authors: Adil
authors: Raihan
authors: R
authors: Sajid
authors: Mohammad
authors: M
authors: Usman
authors: Bushra
authors: B
authors: Moiz
authors: Ghulam Nabi
authors: GN
authors: Kakepoto
authors: Mohammad
authors: M
authors: Khurshid
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011379:Prognosis; D011446:Prospective Studies; D011696:Purpura, Thrombocytopenic / Q000097:blood / Q000175:diagnosis / Q000628:therapy*; D012008:Recurrence; D012307:Risk Factors; D013156:Splenectomy / Q000379:methods*; D017211:Treatment Failure
chemical_list: D005938:Glucocorticoids