Association of Immune Thrombocytopenic Purpura with Non-Bleeding Symptoms
Authors: Talwar Sumit , Varma Mala 
Published: October 2019

Abstract
Abstract 4674
Immune thrombocytopenic purpura (ITP) is an autoimmune disorder defined by isolated thrombocytopenia in the absence of a clinically apparent cause. The patients most commonly report mild to moderate bleeding symptoms; severe bleeding is rare even with very low platelet counts. Patients with ITP have been shown to have a reduced quality of life compared to the general population, as shown by McMillan et al using the SF-36 questionnaire. Also, patients receiving treatment for ITP have been shown by Mathias et al, using the ITP-PAQ (patient assessment questionnaire), to have significantly lower scores for health-related scales including symptoms, fatigue/sleep, bother, activity, psychological health, and overall quality of life in comparison with patients with ITP not on treatment.
Blatt et al reported that thrombocytopenia per se can manifest with constitutional symptoms which resolve with improvement of thrombocytopenia. They conducted a retrospective data review of 27 patients (between ages 6 months to 15 years) and showed that 6 (22%) patients, including 4 patients with chronic ITP, reported fatigue related to their low platelet counts. Their symptoms improved with an increase in the platelet counts. There is no data in the adult population regarding the presence of any symptoms other than bleeding as a manifestation of thrombocytopenia.
We conducted a retrospective chart review involving patients diagnosed with ITP between January 2002 and August 2010. All these patients were followed by a single physician hence reducing reporting bias. A total of 30 patients with a median age of 49 years (range 30 yrs to 84 yrs) were included in the study. The male to female ratio was 3:7. Based on the experience with one patient who complained of fatigue associated with thrombocytopenia which improved with an increase in platelet counts, the physician decided to collect data on all constitutional symptoms associated with thrombocytopenia. All of the comorbidities and any coexistent abnormalities which could explain these symptoms were recorded. A total of 8 (26.7%) patients with a median age of 44 years (range 31 yrs to 75 yrs) reported fatigue associated with lower platelet counts; of these patients, one patient also complained of headaches and one patient also complained of bone pain (Table 1). The median platelet count at presentation was 13,000/μ L (range 3000/μ L – 75,000/μ L). All of these symptoms resolved with an increase in their platelet counts. Nine patients out of the total population were on chronic danazol treatment; only one of these patients complained of fatigue. None of the patients received chronic steroid therapy.
Table 1: Characteristics of patients complaining of constitutional symptoms related to a decrease in platelet counts from their baseline. Subject Age (yrs) Sex (M: male, F: female) Symptom Platelet count at presentation (/μ L) 1 31 F Fatigue 22,000 2 69 F Fatigue 13,000 3 75 F Fatigue 9,000 4 49 F Fatigue 75,000 5 37 F Fatigue 10,000 6 44 M Fatigue 3,000 7 44 F Fatigue, Bone pains 38,000 8 40 F Fatigue, Headache 28,000
This is the first study in an adult population to assess the relationship of thrombocytopenia to constitutional symptoms. Our results are comparable to those reported in the pediatric population by Blatt et al. The mechanism of fatigue in relation to low platelet counts is not clear. Currently, treatment guidelines for ITP are based upon platelet counts and the risk of bleeding. However, further studies will be needed to evaluate if fatigue or any other symptoms which can impair the quality of life of patients can also become an important factor in deciding treatment initiation.

Disclosures:
No relevant conflicts of interest to declare.