A SINGLE CENTER ANALYSIS OF PRIMARY AND SECONDARY IMMUNE THROMBOCYTOPENIC PURPURA (ITP) IN THE MALAYSIAN POPULATION

Abstract

Background: Immune thrombocytopenic purpura (ITP) is characterized by destruction of platelets by autoantibodies produced through immune-mediated mechanism. Various etiologies have been implicated for the development of ITP and there is geographical variation in the prevalence and incidence of this disorder. This retrospective study is to evaluate the prevalence of ITP in a tertiary referral center for hematology, and the spectrum of clinical manifestations. Methodology: This is large cohort of ITP patients from a tertiary hematology clinic Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia. The study was performed in 2019 and included all patients with ITP seen in the clinic till the time this study was conducted. Patients’ information were retrieved from the clinic records. Socio-demographic characteristics, platelet counts, serological markers and hematological complications were evaluated. Results: A total of 241 patients with immune thrombocytopenic purpura (ITP) were included. The mean age was 46.37 ± 18.19 years. Higher prevalence of ITP was seen in Malays (44.4%) followed by Chinese (31%) and Indian (21%) with female to male ratio of 3:1. The prevalence of primary ITP (pITP) was substantially higher (69.7%) than secondary ITP (30.3%). ANA was negative in 61% and positive in 39%. SLE was diagnosed in 22% of patients, the majority (81%) of whom did not have any haemorrhagic manifestations. Only 7.9% of these patients had a positive anti- dsDNA antibody test. Mild haemorrhagic manifestations (grade1) was seen 53.9% and the average platelet count was 69.0 +- 73.35 x103/l. Conclusion: Our study showed that primary ITP was more prevalent than secondary ITP. Antinuclear antibody negative (ANA) associated ITP accounted for the majority of cases. Hemorrhagic manifestations occur in almost half of the studied patients.