Clinical Epidemiology, Treatment Outcome and Mortality Rate of Newly Diagnosed Immune Thrombocytopenia in Adult Multicentre Study in Malaysia

Abstract

Roszymah Hamzah,1,2 Nurasyikin Yusof,1 Nor Rafeah Tumian,3 Suria Abdul Aziz,1 Nur Syahida Mohammad Basri,1 Tze Shin Leong,2 Kim Wah Ho,2 Veena Selvaratnam,2 Sen Mui Tan,2 Siti Afiqah Muhamad Jamil4 1Department of Pathology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia; 2Department of Haematology, Ampang Hospital, Ampang, Selangor, Malaysia; 3Haematology Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia; 4Faculty of Computer and Mathematical Sciences, Universiti Teknologi Mara, Shah Alam, Selangor, MalaysiaCorrespondence: Nurasyikin Yusof, Department of Pathology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Center, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur, 56000, Malaysia, Tel [phone], Fax [phone], Email [email protected]: Immune thrombocytopenia (ITP) is well characterized in Western, European and other Asia-Pacific countries. Nevertheless, the clinical epidemiology, treatment pattern and disease outcome of ITP in Malaysia are still limited and not well known.Objective: This study aimed to describe the clinical epidemiology, treatment outcome and mortality of ITP patients in haematology tertiary multicentre in Malaysia.Methods: Clinical and laboratory data of newly diagnosed adults with ITP by a platelet count < 100 × 109/L from January 2010 to December 2020 were identified and analyzed.Results: Out of 500 incident ITP, 71.8% were females with a striking age preponderance of both genders among those aged 18– 29 years. The median age was 36 years. The median platelet count was 17.5 × 109/L, 23.0% had a secondary ITP, 34.6% had a Charlson’s score ≥ 1, 53.0% had bleeding symptoms including 2.2% intracranial bleedings (ICB). Helicobacter pylori screening was performed in < 5% of cases. Persistency and chronicity rates were 13.6% and 41.8%, respectively. Most (80.6%) were treated at diagnosis onset and 31.2% needed second-line treatment. Throughout the course of ITP, 11.0% of patients died; 3.0% and 8.0% with bleeding and non-bleeding related ITP.Conclusion: This study confirms the epidemiology of ITP is comparable with worldwide studies. Our incidence is high in the female, Malay ethnicity, primary ITP and events of cutaneous bleeding at ITP onset with 18– 29 years predominance age group for both genders. The frequency of persistent and chronic ITP is inconsistent with published literature. Corticosteroids and immunotherapies are the most prescribed first-line and second-line pharmacological treatments. Thrombopoietin receptor agonist medications (TPO-RAs) usage is restricted and splenectomy is uncommon. Our mortality rate is similar but ITP related bleeding death is fourth-fold lower than previous studies. Mortality risks of our ITP patients include age ≥ 60 years, male, severe bleeding at presentation, CCI≥ 1 and secondary ITP.Keywords: epidemiology, immune thrombocytopenia, mortality, treatment outcome

Keywords

• epidemiology
• immune thrombocytopenia
• mortality
• treatment outcome