Analysis Of Clinical And Prognostic Factors With Idiopathic Thrombocytopenic Purpura

Objective To analysis the clinical features and the effects of various treatment,to identify prognostic factors of patients with idiopathic thrombocytopenic purpura.Methods We retrospectively reviewed a cohort of 602 consecutive patients with ITP, diagnosed between 2002～2009 in The third Xiangya Hospital of Central South University, and statistic alanalysis was carried out with the SPSS13.0.Results Of the 602 ITP patients, the 277 cases are chidren, the male to female ratio was 1.31:1, age 10 dayses～14 yearses, median age was 32 monthses,161 caseses(58.2%) had a history of infection before onset, and the upper respiratory tract infection accounted for 64.6% of the incentives; 152 caseses(54.9%) had no or mild bleeding,107 caseses(38.7%) had moderate bleeding and 18 caseses(6.4%) had severe bleeding, mean platelet count before treatment was(20.8±16.8)×109/L,45 caseses(16.3%) had severe anemia; The 325 cases are adult, the male to female ratio was 1:2.13, the aged 15～84 yearses, the median age was 30.2 years old, the 30 caseses(9.2%) had history of recent viral illness before onset, the 138 caseses(42.5%) had no or mild bleeding,146 caseses(44.9%) had moderate bleeding, and 41 caseses(12.6%) had severe bleeding, mean platelet count before treatment was(20.52±19.26)×109/L, and 73 caseses(22.4%) had anemia above the moderate degree.137 pediatric patients were followed up,107(78.1%) achieved remission (R),no remission (NR) in 30 cases (21.9%); 157 adults were followed up,99 patients (63.1%) achieved remission (R),no remission (NR) in 58 cases (36.9%). Effects related factors:short course,increased bone marrow megakaryocytes and high peak of platelets count within 2 weeks after treatment indicate good prognosis for children and adults ITP, (P<0.05). children who have a good prognosis are younger, have shorter time for platelets beganning to increase after treatment, and have higher proportion of lymphoid in bone marrow (P <0.05), adults who have a good prognosis have higher white blood cell counts and platelet counts befor treatment(P<0.05).Conclusion 1. Children is more likely to be AITP, to have infected inducement before onset and to achieve spontaneous remission; adult is more commomly to be chronic process, less likely to have infected inducement, usually occurs in women of reproductive age.2.muco-cutaneous bleeding is the most common clinical presentation of ITP, but severe bleeding is rare.3.higher white blood cells and platelet count befor treatment may suggest good prognosis of adult.3. both children and adults with shorter duration,higher platelet peak within 2 weeks after treatmen and increased bone marrow cells may have a better outcom.4.Younger age, shorter time for platelet started to rise, and a high portion of lymphoid in bone marrow may suggest good prognosis of ITP children...