Evaluation of Treatment Responses in Patients with Immune Thrombocytopenic Purpura

INTRODUCTION: Immune thrombocytopenic purpura (ITP) is an autoimmune disorder characterized by immune-mediated platelet destruction and, in some cases, impaired platelet production. While conventional therapies, such as corticosteroids, IVIg, and splenectomy, are effective for most patients, refractory ITP remains a significant clinical challenge. This study aimed to evaluate the demographic characteristics, clinical features, treatment responses, and outcomes of hospitalized ITP patients in a real-world setting.
METHODS: This retrospective study included 60 ITP patients treated in the Internal Medicine Clinics of Ankara Numune Training and Research Hospital between 2009 and 2013. Patients with platelet counts <30 × 109/L were analyzed for demographic data, clinical presentations, treatments received during hospitalization, and treatment responses. Statistical analyses were performed to identify factors associated with treatment outcomes.
RESULTS: The cohort comprised 43 females (72.7%) and 17 males (27.3%), with a mean age of 47.6±16.9 years. First-line steroid therapy achieved a 65% response rate, with non-responders more likely to experience major bleeding (p = 0.039). Second-line therapies included IVIg (66.7% response rate) and splenectomy (53.8% response rate), with lower responses observed in refractory cases. Rituximab, vincristine, and eltrombopag response rates were 33.3%, 20%, and 33.3%, respectively. Two patients were resistant to all treatments; one died due to major bleeding, yielding a 1.6% mortality rate over four years.
DISCUSSION AND CONCLUSION: Refractory ITP presents a significant treatment challenge, particularly in patients resistant to multiple therapies. While combination therapies and novel agents, such as TPO receptor agonists, hold promise, further randomized controlled trials are necessary to establish standardized treatment protocols and improve outcomes in refractory cases.