Idiopathic Thrombocytopenic Purpura in Elderly Patients: A Two-center Retrospective Study of 41 Cases

Emmanuel Andres, Abrar Ahmad Zulfiqar, Khalid Serraj, Jacques Zimmer, Thomas Vogel and Frederic Maloisel

Objective: This work aimed to report our observations on idiopathic or immune thrombocytopenic purpura (ITP) in elderly patients.

Patients and Methods: We retrospectively reviewed a cohort of 41 consecutive elderly ITP patients (≥65 years old) in two ITP reference centers, namely the university hospital groups of Strasbourg and Reims, France. We particularly analyzed patient clinical characteristics, along with the therapies used and side-effects, and patient response rates.

Results: The mean age of the 41 patients was 76.7 years (range: 65-91), 21 (51%) were older than 75 years and 27 were female. Initial presentations included the following: thrombocytopenia revealed by routine blood count or bleeding limited to the skin in 27 cases (66%); severe cutaneous bleeding or visceral bleeding in one or more other sites in 14 (34%). The mean platelet count was 34.4 x 109/L (range: 1-120). Spontaneous remission and complete response under therapy were reported in eight patients (20%) and 33 (80%) still exhibited chronic ITP at time of writing. There were three deaths during long-term follow-up. After 6 months, the response rate was 35% with corticosteroids, 50% with splenectomy, and 40% with danazol. Side-effects were reported in 100% of elderly ITP patients, with 60% and 50% corresponding to corticosteroids and danazol, respectively. The response rate to biological agents, namely rituximab and thrombopoietin (TPO) receptor agonists, was 80%, with no adverse effects observed.

Conclusions: Our results confirm that age influences the hemorrhagic pattern of ITP expression as well as responses to and adverse effects of conventional ITP therapies.