Immune thrombocytopaenic purpura: 11-year experience in Ile-Ife, Nigeria

Immune thrombocytopaenic purpura (ITP) is believed to be rare in indigenous black Africans and people of African extraction in other parts of the world, compared to reports among the Caucasians. This paper is therefore aimed at investigating the incidence, clinical features and course of ITP managed at the Obafemi Awolowo University Teaching Hospitals Complex Ile-Ife over the past 11 years. The study was both retrospective and prospective. Case notes of patients confined to have ITP were retrieved and studied. Clinical, haematologic as well as management protocols and outcomes were evaluated. Diagnosis was based on the presence of haemorrhagic manifestations, thrombocytopaenia with normal or increased bone marrow megakaryocytes. Hopital incidence of the disease was computed from all hospital admissions in the period under review. There were eleven cases (7 females, 4 males), aged 10 to 55 (median, 21) years. Eight (72.7%) of the patients presented within one week of onset of symptoms. None of the patients had a history of any overt infection. Two patients (18%), both females were positive for lupus erythematosus (LE) test. Eighty percent of the patients presented with severe thrombocytopaenia (platelet count < 10 x 10(9)/l), while 72% had severe anaemia (PCV < or = 25%) requiring blood transfusion. Remission was induced within 4 weeks in 92% of patients, using oral prednisolone. Immunosuppressive treatment with cyclophosphamide was required to achieve remission in one patient. The overall prevalence rate is 0.005% of hospital cases. The review confirms rarity of ITP in this population and its female preponderance (F:M ratio 1.8:1). Although clinically severe, response to corticosteroid therapy is impressive. No patient underwent splnectomy.