Clinicopathologic and prognostic features of chronic idiopathic hrombocytopenic purpura in adult Chinese patients: an analysis of 220 cases

To determine the clinicopathologic and prognostic features of chronic idiop athic thrombocytopenic purpura. (ITP) in adult Chinese patients, we conduct ed a retrospective analysis of 220 patients seen at a single center over a 40-year period. The female-to-male ratio was 4:1, with a mean age of 42.1 /- 1.3 years, a mean platelet count of 33.7 +/- 2.3x10(9)/l, and a mean fol low-up of 116+/-7 months. Initial steroid treatment was required in 142 pat ients, 67 of whom (47.2%) achieved complete remission (CR). At 470 months, 46% patients remained in CR. Splenectomy was performed in 37 patients: in 2 3 patients due to primary steroid refractoriness and in 7 patients due to d isease relapse following initial CR with steroids. In seven patients, data on response to steroids prior to splenectomy were not available. Splenectom y for steroid nonresponders resulted in an inferior CR rate (13 of 23, 56%) as compared with that for relapses after steroid treatment (7 of 7, 100%) (P<0.05). Compared with patients with negative antinuclear antibody (ANA), those who were ANA positive had similar responses to steroids, but signific antly shorter remission after splenectomy (P<0.01). In conclusion, Chinese patients with ITP could maintain long-term remission after steroid therapy and splenectomy. In addition, primary steroid refractoriness and positive A NA were bad prognostic factors of the subsequent response to splenectomy.