Immune thrombocytopaenic purpura: 11-year experience in Ile-Ife, Nigeria.

Abstract

Immune thrombocytopacnic purpura (ITP) is believed to be rare in indigenous black African s and people of African extraction in other parts o f the world, compared to reports among the Caucasians. This paper is therefore aimed at investigating the incidence, clinical features and course of ITP managed at the Obafemi Awolowo University Teaching Hospitals Complex Ile-Ife over the past 11 years. The study w a s both retrospective and prospective . Case notes of patients confirmed to have ITP were retrieved and studied. Clinical, haematologic as well as management protocols and outcomes were evaluated. diagnosis was based on the presence of haemorrhagic manifestations, thrombocytopaenia with normal or increased bone marrow megakaryocytes. Hospital incidence of t h e disease w a s compute d from all hospital admissions in the period under review. There were eleven cases (7 females, 4 males), aged 10 to 55 (median, 21) years. Eight (72.7%) o f the patients presented within one week of onset of symptoms. Non e of the patients had a history of any overt infection. Two patients (18%), both females were positive for lupus erythematosus (LE) test. Eighty percent of the patients presented with severe thrombocytopaenia (platelet count < 1 0 x 109 /1), while 7 2 % had severe anaemia (PCV < 25% ) requiring blood transfusion. Remission was induced within 4 week s in 9 2 % o f patients, using oral prednisolone . Immunosuppressive treatment with cyclophosphamide w a s required to achieve remission in one patient. The overall prevalence rate is 0.005 % o f hospital cases. The review confirms rarity o f T IP in this population and its female preponderance (F:M ratio 1.8:1). Although clinically severe , response to corticosteroid therapy is impressive. No patient underwent splnectomy.