Seasonal Association of Immune Thrombocytopenia in Adults

Year 2015, Volume: 32 Issue: 4, 347 - 351, 01.10.2015

Anıl Tombak Naci Tiftik Burcu Boztepe Melda Cömert Güray Saydam Ozan Salim Emel Gürkan Kaniye Aydın Emel Gürkan Mehmet Ali Sungur

Abstract

Background: Immune thrombocytopenia (ITP) is an autoimmune disorder. It is characterized by thrombocytopenia due to thrombocyte destruction mediated by autoantibodies; however, cytotoxic and defective regulatory T-lymphocytes play an important role in its pathogenesis. While childhood ITP is usually acute, self-limiting and generally seasonal in nature, ITP in adults is usually chronic; its relation with seasons has not been studied. Aims: We investigated whether months and/or seasons have triggering roles in adults with ITP. Study Design: Descriptive study. Methods: A retrospective case review of adult patients with primary ITP diagnosed at various University Hospitals in cities where Mediterranean climate is seen was performed. Demographic data, date of referral and treatments were recorded. Corticosteroid-resistant, chronic and refractory cases were determined. Relation between sex, corticosteroid-resistant, chronic and refractory ITP with the seasons was also investigated. Results: The study included 165 patients (124 female, mean age=42.8±16.6). Most cases of primary ITP were diagnosed in the spring (p=0.015). Rates of patients diagnosed according to the seasons were as follows: 35.8% in spring, 23% in summer, 20.6% in fall, and 20.6% in winter. With respect to months, the majority of cases occurred in May (18.2%). Time of diagnosis according to the seasons did not differ between genders (p=0.699). First-line treatment was corticosteroids in 97.3%, but 35% of the cases were corticosteroid-resistant. Steroid-resistant patients were mostly diagnosed in the spring (52.1%) (p=0.001). ITP was chronic in 52.7% of the patients and they were also diagnosed mostly in the spring (62.7%) (p=0.149). Conclusion: This is the first study showing seasonal association of ITP in adults and we have observed that ITP in adults is mostly diagnosed in the spring. The reason why more patients are diagnosed in the spring may be due to the existence of atmospheric pollens reaching maximum levels in the spring in places where a Mediterranean climate is seen.

Keywords

Allergens, immune thrombocytopenia, pollen, seasons

References

• 1. Frederiksen H, Schmidt K. The incidence of idiopathic thrombocytopenic purpura in adults increases with age. Blood 1999;94:909-13.
• 2. Neylon AJ, Saunders PWG, Howard MR, Proctor SJ, Taylor PR; Northern Region Haematology Group. Clinically significant newly presenting autoimmune thrombocytopenic purpura in adults: a prospective study of a population-based cohort of 245 patients. Br J Haematol 2003;122:966-74. [CrossRef]
• 3. Schoonen WM, Kucera G, Coalson J, Li L, Rutstein M, Mowat F, et al. Epidemiology of immune thrombocytopenic purpura in the general practice research database. Br J Haematol 2009;145:235-44. [CrossRef]
• 4. Kurata Y, Fujimura K, Kuwana M, Tomiyama Y, Murata M. Epidemiology of primary immune thrombocytopenia in children and adults in Japan: a population-based study and literature review. Int J Hematol 2011;93:329-35. [CrossRef]
• 5. Kashiwagi H, Tomiyama Y. Pathophysiology and management of primary immune thrombocytopenia. Int J Hematol 2013;98:24-33. [CrossRef]
• 6. Neunert C, Lim W, Crowther M, Cohen A, Solberg L Jr, Crowther MA; American Society of Hematology. The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia. Blood 2011;117:4190-207. [CrossRef]
• 7. Rodeghiero F, Stasi R, Gernsheimer T, Michel M, Provan D, Arnold DM, et al. Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood 2009;113:2386-93. [CrossRef]
• 8. Nugent DJ. Childhood immune thrombocytopenic purpura. Blood Rev 2002;16:27-9. [CrossRef]
• 9. Provan D, Stasi R, Newland AC, Blanchette VS, Bolton-Maggs P, Bussel JB, et al. International consensus report on the investigation and management of primary immune thrombocytopenia. Blood 2010;115:168-86. [CrossRef]
• 10. Stasi R, Amadori S, Osborn J, Newland AC, Provan D. Long-term outcome of otherwise healthy individuals with incidentally discovered borderline thrombocytopenia. PLoS Med 2006;3. [CrossRef]
• 11. Zeller B, Rajantie J, Hedlund-Treutiger I, Tedgård U, Wesenberg F, Jonsson OG, et al. Childhood idiopathic thrombocytopenic purpura in the Nordic countries: epidemiology and predictors of chronic disease. Acta Paediatr 2005;94:178-84. [CrossRef]
• 12. Hafiz MG, Mannan MA, Amin SK, Islam A, Rahman F. Immune thrombocytopenic purpura among the children attending at two teaching hospitals. Bangladesh Med Res Counc Bull 2008;34:94-8.
• 13. Moulis G, Palmaro A, Montastruc JL, Godeau B, Lapeyre-Mestre M, Sailler L. Epidemiology of incident immune thrombocytopenia: a nationwide population-based study in France. Blood 2014;124:3308-15. [CrossRef]
• 14. Rand ML, Wright JF. Virus-associated idiopathic thrombocytopenic purpura. Transfus Sci 1998;19:253-9. [CrossRef]
• 15. Moulis G, Sommet A, Sailler L, Lapeyre-Mestre M, Montastruc JL; French Association Of Regional Pharmacovigilance Centers. Drug-induced immune thrombocytopenia: a descriptive survey in the French PharmacoVigilance database. Platelets 2012;23:490-4. [CrossRef]
• 16. Garbe E, Andersohn F, Bronder E, Salama A, Klimpel A, Thomae M, et al. Drug-induced immune thrombocytopenia: results from the Berlin Case-Control Surveillance Study. Eur J Clin Pharmacol 2012;68:821-32. [CrossRef]
• 17. Grimaldi-Bensouda L, Michel M, Aubrun E, Leighton P, Viallard JF, Adoue D, et al; PGRx Immune Thrombocytopenia Study Group. PGRx Immune Thrombocytopenia Study Group. A casecontrol study to assess the risk of immune thrombocytopenia associated with vaccines. Blood 2012;120:4938-44. [CrossRef]