A Three Year Experience at An Inner City Safety-Net Hospital with Immune Thrombocytopenic Purpura (ITP)

Immune Thrombocytopenic Purpura or ITP remains a clinical diagnosis of exclusion. There are numerous treatments, attesting to the fallibility of each. A 3 year experience at an Inner City safety net hospital was analyzed. For inclusion in the study, the hematology service had to have excluded consumption disorders, prior chemotherapy, medication known to cause thrombocytopenia and Viral Infection- HIV and/Hepatitis. 93 patients met these criteria and had platelet counts below 50,000. The median age of the whole group was 49 yrs, with a range of 21 to 78 years. A few were ANA positive. The female preponderance reflects the literature.

All Patients were started on Prednisone at 1mg/kg. Three Patients also received IV IGG to hasten the response. There were no intracranial hemorrhages or bleeding described as major.

Patients from the Far East had to be excluded for Hepatitis Virus exposure.

All who did not respond to steroids fully were treated with a second line Rx. i.e, Rituximab, Azathioprine, IV IGG or WIN Rho. One patient received high dose Dexamethasone and responded.

Pending the use of TPO agonists, treatment of ITP in adults remains a chronic problem challenging the Hematologist to use as little corticosteroid as possible.

No relevant conflicts of interest to declare.