Identifying the characteristics, natural behavioral pattern, and response to therapy in ITP in a multi-center population in Sri Lanka

Abstract

Objective: To describe some selected characteristics of immune thrombocytopenia (ITP) such as presentation, the disease pattern, treatment options, and response to therapy and side effects to common therapeutic options. Methods: A group of 72 patients diagnosed as ITP were studied over a period of 5 years in two main centers in Sri Lanka. Characteristics of the disease such as presentation, the disease pattern, treatment options, and response to therapy and side effects to common therapeutic options were studied. Results: The ages of the patients ranged from 12 to 71 years but the majority (64.2%) were between 20 and 45 years. In 47 (65.3%) the average platelet count at presentation was below 30 × 109/l and in these patients there was a significant increase in bleeding manifestations. Sixty-nine patients were given steroids as the initial treatment and all had responded initially. Time to respond ranged from 3 to 30 days with an average of 11 days. Twenty-four patients developed steroid-related side effects. In 24 patients second-line treatment options such as dapsone, azathioprine, and danazole were given but a satisfactory response to them could not be demonstrated. Discussion: The heterogeneous behavioral patterns of the disease with patients who are having the same platelet count (<30 × 109/l) were observed and this revealed that ITP needs an individualized approach regardless of the platelet count of the patient. A close follow-up of the patients revealed that the patient's understanding of the disease and ability to identify the warning signs resulted in less intervention with drugs which lead to many harmful long-term side effects.