How I treat idiopathic thrombocytopenic purpura (ITP)

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Abstract
Until recently, experience from numerous centers over more than a half-century indicated that the typical adult with ITP is a woman, generally between 18 and 40 years of age.6 Gender disparity largely disappears among the elderly.6,7 Two recent publications have questioned this perception. The first was a survey from a single county in Denmark using International Classification of Disease (ICD) codes at hospital discharge over a 22-year period. The female-male ratio was 1.7, the median age at diagnosis was 56 years, and the incidence of ITP increased with age and increased overall during the period of study.8 The second was a prospective cohort analysis of newly presenting adults with platelet counts less than 50 000 × 109/L in the Northern Health Region of the United Kingdom. The female-male ratio was 1.2 and, again, the age-specific incidence was highest among those older than 60 years.9 Presenting symptoms, severity of thrombocytopenia, and response to therapy were typical for ITP, so these data do not simply reflect increased detection of mild cases based on automated platelet determinations,10 misdiagnosed myelodysplasia (MDS),11 or drug-dependent antibodies.

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