Immune thrombocytopenia: A retrospective study of 40 patients

Purpose. - Immune thrombocytopenia (ITP) is an auto-immune disease associating a peripheral platelet destruction without increased central production. Methods. - Forty patients with chronic ITP were retrospectively analyzed for clinical and biological presentation and response to treatment. Results.- Mean age at diagnosis was 54 years. lip was revealed by hemorrhage in 65 % of the patients. Despite very low platelet count, no life threatening hemorrhage was observed. Platelet associated antibodies were found in 66%. usually directed against GPIIb/IIIa. Corticosteroids were used as first line treatment, with response in 54%. and relapse in 86%. A response was observed in 42.1% with dapsone, which was well tolerated, a relapse occurring in 37.5% of the patients. Rituximab (RTX) allowed a response rate of 42.1%, prolonged in 40% of the patients. A response was achieved in 42.9% cases after splenectomy, without any relapse. No factor was identified to predict the response to treatment. Conclusion. - ITP is a rare disorder occurring most frequently in middle aged patients. Because of high relapse or no response rates, many treatments should be used. Dapsone offers a good efficacy without major side effects. RTX is well tolerated and allows a good response rate. The use of new agents like thrombopoietin receptor agonist or new therapeutics against B lymphocytes should be defined. (C) 2010 Societe nationale francaise de medecine interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.