A CLINICAL STUDY OF PATIENTS WITH IDIOPATHIC THROMBOCYTOPENIC PURPURA

摘要

OBJECTIVE To study the incidence, age and sex distribution among adults, various modes of presentation, correlation between thrombocytopenia and bleeding manifestations and various modalities of treatment of Idiopathic Thrombocytopenic Purpura in a tertiary care hospital in India. MATERIALS AND METHODS Prospective study consisting of 4o cases of ITP admitted to Kasturba Medical College Hospital, Manipal from November 2005 to March 2007. Patients above 14 years of age admitted with thrombocytopenia in this institution were screened based on detailed clinical history, physical examination and laboratory investigations. RESULTS The maximum incidence was in the 3 rd decade of life accounting for 27.5% of the patients. Ratio of male to female was 1:1.9 with female preponderance. Females in 3 rd decade had maximum incidence while males in 4 th decade have maximum incidence. Majority 12 (85.71%) of male patients and 15(57.69%) of female patients developed purpura during the course of disease. The mean count was 17.8X10 9 /L with range between 2.0 X10 9 /L to 76 X10 9 /L. Cutaneous bleeding spots were found to be assosiated with counts above 25000X10 9 /L and hematuria with lowest counts around 4000 X10 9 /L. 20 (50%) of the above 40 patients responded to corticposteroids alone and did not have any further relapse. Among the remaining patients 3 (7.5%) had a relapse of symptoms within next 6 months and responded to repeat prednisolone started at 1mg/kg. 2 (5%) patients were given steroids tapering dose with IV Immune globulins for initial 5 days as therapy to which they responded. CONCLUSION Idiopathic thrombocytopenia is 1.9 times more common in females than males. Most common presentation is bleeding spots over body. Bleeding manifestations are more common with thrombocytopenia less than 30000/mm 3 . Corticosteroids are the mainstay in treatment. Complete remission is seen in up to 57.5% of the patients. Splenectomy is the second modality of treatment in ITP. Complete and sustained remission is seen 75% of patients.