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Hamostaseologie 2019; 39(03): 238-249
DOI: 10.1055/s-0039-1683416
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Epidemiology and Clinical Manifestations of Immune Thrombocytopenia

Rahil Kohli
1   Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
,
Shruti Chaturvedi
1   Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
› Author Affiliations
Further Information

Publication History

03 September 2018

05 February 2019

Publication Date:
13 March 2019 (online)

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Abstract

Immune thrombocytopenia (ITP) occurs with an incidence rate of 1.6 to 3.9 per 100,000 patient-years, which increases with age and has a slight female preponderance. ITP is termed acute, persistent or chronic when its duration is <3 months, 3 to 12 months and >12 months, respectively. In this narrative review, we discuss the clinical manifestations of ITP in children and adults. ITP is asymptomatic in some patients; however, when present, bleeding is the most common symptom and can be mild as in petechiae, purpura and epistaxis, or severe and even life threatening in cases of intracranial haemorrhage, and massive gastrointestinal or urinary tract bleeding. A platelet count <10–20 × 109/L, advanced age and prior minor bleeding are risk factors for major bleeding, which is also more common in the months following a new diagnosis of acute ITP. Fatigue and impaired health-related quality of life are also manifestations of ITP that often improve with treatment and improvement in platelet counts. Over long-term follow-up, ITP is also associated with an increased risk of venous and arterial thromboembolism, haematologic malignancy and overall mortality than the general population.

Zusammenfassung

Die Immunthrombozytopenie (ITP) tritt mit einer Inzidenzrate von 1,6 bis 3,9 pro 100.000 Patientenjahre auf, die mit zunehmendem Alter zunimmt und ein geringes Überwiegen der Frauen aufweist. ITP wird als akut, persistent oder chronisch bezeichnet, wenn die Dauer <3 Monate, 3 bis 12 Monate bzw.> 12 Monate beträgt. In dieser narrativen Übersichtsarbeit diskutieren wir die klinischen Erscheinungsformen von ITP bei Kindern und Erwachsenen. ITP ist bei manchen Patienten asymptomatisch; Blutungen sind jedoch, wenn vorhanden, das häufigste Symptom und können mild sein, wie bei Petechien, Purpura und Epistaxis, oder sogar schwer oder gar lebensbedrohlich bei intrakraniellen Blutungen oder massiven Blutungen im Gastrointestinal- oder Harntrakt. Eine Thrombozytenzahl <10–20 × 109 / L, ein fortgeschrittenes Alter und frühere geringfügige Blutungen sind Risikofaktoren für starke Blutungen, die auch häufiger in den Monaten nach einer neuen Diagnose einer akuten ITP auftreten. Erschöpfung und Beeinträchtigung der gesundheitsbezogenen Lebensqualität sind auch Manifestationen von ITP, die sich häufig durch Behandlung und Erhöhung der Thrombozytenzahl verbessern. Im langjährigen Follow-Up ist ITP auch mit einem höheren Risiko für venöse und arterielle Thromboembolien, hämatologischer Malignität und Gesamtmortalität verbunden als in der allgemeinen Bevölkerung.

Keywords

autoimmune diseases - bleeding - immune thrombocytopenia - platelets

Schlüsselwörter

Autoimmunerkrankungen - Blutung - Immunthrombozytopenie - Blutplättchen
 

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