A clinical study of patients with idiopathic thrombocytopenic purpura

Objective: The aim of this study was to analyze the incidence, age and sex distribution among adults, various modes of presentation, correlation between thrombocytopenia and bleeding manifestations, and various modalities of treatment of ITP in a tertiary care hospital in India. Methods: A prospective study included 40 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. Male-to–female ratio was 1:1.9 with female preponderance. Females in the 3^rd decade had maximum incidence while males in the 4^th decade have maximum incidence. The majority (12, 85.71%) of male patients and 15 (57.69%) female patients developed purpura during the course of disease. The mean count was 17.8×10⁹/L with range between 2.0×10⁹/L and 76×10⁹/L. Cutaneous bleeding spots were found to be associated with counts above 25000×10⁹/L and hematuria with lowest counts around 4000×10⁹/L. A number of 20 (50%) of the above 40 patients responded to corticosteroids 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 1 mg/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 <30000/mm³. 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.