Clinical Epidemiology, Treatment Outcome and Mortality Rate of Newly Diagnosed Immune Thrombocytopenia in Adult Multicentre Study in Malaysia

Abstract

Background

Immune thrombocytopenia (ITP) is well characterized in Western, European and other Asia-Pacific countries. Nevertheless, the clinical epidemiology, treatment pattern and disease outcome of ITP in Malaysia are still limited and not well known.

Objective

This study aimed to describe the clinical epidemiology, treatment outcome and mortality of ITP patients in haematology tertiary multicentre in Malaysia.

Methods

Clinical and laboratory data of newly diagnosed adults with ITP by a platelet count <100 × 10⁹/L from January 2010 to December 2020 were identified and analyzed.

Results

Out of 500 incident ITP, 71.8% were females with a striking age preponderance of both genders among those aged 18–29 years. The median age was 36 years. The median platelet count was 17.5 × 10⁹/L, 23.0% had a secondary ITP, 34.6% had a Charlson’s score ≥1, 53.0% had bleeding symptoms including 2.2% intracranial bleedings (ICB). Helicobacter pylori screening was performed in <5% of cases. Persistency and chronicity rates were 13.6% and 41.8%, respectively. Most (80.6%) were treated at diagnosis onset and 31.2% needed second-line treatment. Throughout the course of ITP, 11.0% of patients died; 3.0% and 8.0% with bleeding and non-bleeding related ITP.

Conclusion

This study confirms the epidemiology of ITP is comparable with worldwide studies. Our incidence is high in the female, Malay ethnicity, primary ITP and events of cutaneous bleeding at ITP onset with 18–29 years predominance age group for both genders. The frequency of persistent and chronic ITP is inconsistent with published literature. Corticosteroids and immunotherapies are the most prescribed first-line and second-line pharmacological treatments. Thrombopoietin receptor agonist medications (TPO-RAs) usage is restricted and splenectomy is uncommon. Our mortality rate is similar but ITP related bleeding death is fourth-fold lower than previous studies. Mortality risks of our ITP patients include age ≥60 years, male, severe bleeding at presentation, CCI≥1 and secondary ITP.

Keywords:

• epidemiology
• immune thrombocytopenia
• mortality
• treatment outcome

Future Directions

This study has paved the way for the development of a local national ITP registry or a population-based surveillance system. This registry will enable us to obtain data which is useful for standardization of local clinical practice, explore new research and novelty findings in ITP patients in Malaysia including study for possible platelet disorders in refractory and cITP group. It is also our hope that with this data/registry, we are able to pave easier access to TPO-RAs that will benefit all individuals diagnosed with ITP.

Data Sharing Statement

Study data are available on request from the corresponding author.

Acknowledgments

The authors are grateful to Assoc. Prof. Dr. Ahmad Sabry Mohamad, to all clinical and laboratory staff at the Haematology Department, Ampang Hospital and HCTM, UKMMC for their participation, dedication and valuable assistance in this study. We thank the Malaysian government and National Registration Department for assisting in data collection and the medical record library for providing medical record provision. Part of this paper was supported by a grant from the Malaysian Society of Haematology.

Disclosure

The authors report no conflict of interests.