Características clínicas e epidemiológicas dos pacientes com trombocitopenia imune da Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas de 2012 a 2019

Abstract

Immune thrombocytopenia (ITP) is defined as a platelet count <100 x 109 / L mediated by immune destruction and without association with recognizable pathology. In relation to the diseases phases, it’s classified as "newly diagnosed", "persistent" and "chronic" ITP. Clinical manifestations are variable, from an asymptomatic condition to intracranial hemorrhage. In most children, recovery is spontaneous, while in adults it is chronic. Response to treatment is variable and / or limited. The objective of this study is to know the clinical and epidemiological characteristics of patients with ITP treated at the Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas - HEMOAM. Method: A descriptive and retrospective study of ITP cases treated from 2012 to 2019 realized at the HEMOAM Foundation. Data collection was carried out in the medical records of patients ITP ́s diagnosed with platelet counts <100 x 109 / L in the hemogram and who were referred to the first time to the hematology service due to isolated thrombocytopenia. Results: The sample consisted of 621 patient records, 58.78% adults and 41.22% children. The majority were women (61.19%), mixed race (59.74%), aged group from 17 to 30 years in adults and from 1 to 4 years in children. The ITP classification in relation to etiology identified 34.3% of primary ITP and 65.7% of secondary ITP. The main cause of secondary ITP was upper respiratory tract infection (17.4%). In relation to primary ITP were identified 31% of newly diagnosed ITP, 28% persistent ITP and 41% chronic ITP. The mean platelet count of patients was 31 x109 / L and in those with severe bleeding episodes was 12 x109 / L. Severe bleeding episodes occurred in 8,4% of the patients (1.9% had epistaxis, 1% digestive bleeding, 0.9% stroke). After the first evaluation, 56% of the patients used corticosteroids as first-line treatment, 65% of them responded positively, 30% became dependent on corticosteroids. Splenectomy was performed in 5.1% of patients, 91% of them had a favorable response. Relapse episodes occurred in 13% of patients. Conclusion: Most cases of thrombocytopenia referred for treatment at the institution were secondary ITPs and many of them were subsequently remitted to the specialist who for follow-up disease`s base. Primary ITP cases were monitored and treated at the HEMOAM foundation. First-line treatment was used very frequently, easily and without difficulty in terms of access; however, second-line treatment was rarely used, indicating unavailability for patients who become persistent or chronic