Immune thrombocytopaenia in adults: a single-centre retrospective review of patients presenting over 7 years.
OBJECTIVE
To compare the investigation and management of adult immune thrombocytopaenia in our institution with international guidelines.


METHODS
Adults presenting with immune thrombocytopaenia over a 7-year period were identified from a database. Written and electronic case records were reviewed. Patient demographics, results of investigations and management were recorded and compared with international guidelines.


RESULTS
ITP was mild or asymptomatic in 57 of 67 patients (85%). Bone marrow aspiration was performed in 45 patients including 23 of 45 patients under 60 yrs. 15 patients (22%) were tested for HIV at presentation. 28 patients (42%) were inpatients including 18 patients who were asymptomatic or mildly symptomatic. 53 patients (79%) received first-line treatment with oral prednisone including 6 who were asymptomatic with platelets >30x10(9)/L. Splenectomy was performed in 17 patients at a median 7 months after diagnosis.


CONCLUSIONS
Guidelines were followed in most cases although bone marrow aspirates were often performed unnecessarily in young patients. HIV testing was infrequently requested and should be considered in all new patients presenting with ITP. Asymptomatic patients have a low risk of serious or life-threatening bleeding and do not require admission to hospital. Most patients will eventually achieve a platelet count >30x10(9)/L off treatment.
McDonald
Emma Jane
EJ
Haematology, Christchurch Hospital, Christchurch, New Zealand.
Butler
Andrew
A
D000328:Adult; D000974:Antibodies, Antinuclear / Q000097:blood; D000972:Antineoplastic Agents, Phytogenic / Q000627:therapeutic use; D001379:Azathioprine / Q000627:therapeutic use; D044963:Biopsy, Fine-Needle / Q000706:statistics & numerical data; D001772:Blood Cell Count; D001779:Blood Coagulation Factors / Q000032:analysis; D001853:Bone Marrow / Q000473:pathology; D005938:Glucocorticoids / Q000627:therapeutic use; D019983:Guideline Adherence; D015658:HIV Infections / Q000175:diagnosis; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016682:Lupus Coagulation Inhibitor / Q000097:blood; D009520:New Zealand / Q000453:epidemiology; D010343:Patient Admission / Q000706:statistics & numerical data; D010976:Platelet Count; D017713:Platelet Transfusion / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011241:Prednisone / Q000627:therapeutic use; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000453:epidemiology / Q000628:therapy*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013156:Splenectomy; D014750:Vincristine / Q000627:therapeutic use
D000974:Antibodies, Antinuclear; D000972:Antineoplastic Agents, Phytogenic; D001779:Blood Coagulation Factors; D005938:Glucocorticoids; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D016682:Lupus Coagulation Inhibitor; D014750:Vincristine; D001379:Azathioprine; D011241:Prednisone