Characteristics and outcome of immune thrombocytopenia in elderly: Results from a single center case‐controlled study

Abstract

The management of ITP in elderly raises several questions that have not been fully addressed in the literature. To assess the impact of ITP in elderly, a case-control study was performed. The main characteristics at onset and the outcome of ITP in 55 patients aged of 70 years and above (cases) were compared with those of 97 younger adults (controls) seen at the same tertiary referral institution. The mean age at diagnosis was respectively 77.8 ± 6.1 years (cases) and 40.3 ± 14.9 years (controls). While the median platelet count at time of diagnosis was not significantly different in cases and controls (6310 9 /L, range: 2-26 versus 12310 9 /L: 5-21.5), bleeding symptoms were more frequent in cases (82%) than in the controls (68%, p50.07), and the median bleeding score was significantly higher in elderly (p50.001). The rate of treatmentrelated adverse events was more than twofold higher in elderly patients and the mean cumulative duration of hospital stay for ITP during the follow-up period was much longer when compared to the controls (p<0.0001). Three ITP-related deaths (5.4%) including 1 from intracranial hemorrhage occurred in the cases but none in the controls. In conclusion, this study confirms that at equivalent platelet count, ITP has a greater impact in elderly. Am. J. Hematol. 86:980-984, 2011. V

How we manage immune thrombocytopenia in the elderly

“…The analytical model developed in this study estimated that patients older than 60 years with a platelet count <30 9 10 9 / l had a predicted 5-year bleeding risk of 48% as compared with 2Á2% for ITP patients younger than 40 years. In a casecontrol study, our group confirmed that at equivalent platelet count, bleeding manifestations were both more frequent and more severe in older patients (>70 years) than younger patients (Michel et al, 2011). In the largest study of older adults with ITP including more than 500 patients, both age and platelet count were risk factors for severe bleeding (Zhou et al, 2013).…”

“…Thus, most guidelines for adult ITP suggest that treatment should be considered when the platelet count is <30 9 10 9 /l and/or with bleeding manifestations (British Committee for Standards in Haematology General Haematology Task Force 2003; Cines & Bussel, 2005;Rodeghiero et al, 2009;Provan et al, 2010;Neunert et al, 2011). In line with these recommendations, a recent retrospective analysis of a population of older ITP patients confirmed that severe bleeding mostly occurred in patients with a platelet count <20 9 10 9 /l (Michel et al, 2011). However, two limits must be underlined: (i) most patients included in these studies were younger than 75 years and (ii) some with a platelet count >50 9 10 9 /l died due to intracranial haemorrhage.…”

“…Corticosteroids are as effective in older adults as in younger patients (Daou et al, 2008;Michel et al, 2011), but their side effects are often underestimated in the ITP setting (Moulis et al, 2015). Gastritis, corticosteroid-induced diabetes, psychosis and infections are among the most frequent adverse events (Cortelazzo et al, 1991;Daou et al, 2008;Tamez-Perez et al, 2015).…”

Epidemiology of incident immune thrombocytopenia: a nationwide population-based study in France

“…The role of exposure to anticoagulant or antiaggregant in these events needs further investigation. 14 The limitations of this study are inherent to all studies in administrative databases. We cannot rule out some misclassifications.…”

“…Therefore, and solely to indicate this fact, this article is hereby marked "advertisement" in accordance with 18 USC section 1734. patients (n 5 340) were included. 13 Bleeding risk might increase with age, 14 but faithful assessment of such rare events needs larger cohorts.…”