Kapoor Rajan, Pati Hara Prasad, Mahapatra Manoranjan, Monga Anuradha
All India Institute of Medical Sciences (AIIMS), Department of Hematology, New Delhi, India E-mail:
Turk J Haematol. 2015 Jun;32(2):158-62. doi: 10.4274/tjh.2013.0161.
Thrombocytopenia poses a significant problem in the elderly. Not only are there varied causes, but it is also associated with significant morbidity and mortality. We carried out a study to learn the causes of isolated thrombocytopenia in elderly patients and to correlate the severity of thrombocytopenia and bleeding manifestations with various etiologic factors and comorbidities.
A total of 108 patients above 50 years of age presenting with isolated thrombocytopenia (platelet counts of <100x109/L with normal hemoglobin and total leukocyte counts) were enrolled in the study. Detailed history and clinical examinations were carried out for each patient. Complete blood counts were analyzed by automated cell counter. Peripheral smears were examined in all cases. HbsAg, anti-HCV, and anti-HIV testing by enzyme-linked immunosorbent assay was done in all patients. Wherever clinically indicated, bone marrow aspiration biopsy and cytogenetic studies were done.
Out of 108 patients, 102 (94.4%) presented with bleeding tendencies. Twenty-nine (26.8%) presented with serious (World Health Organization grade 3/4) bleedings. Major findings were immune thrombocytopenic purpura in 79 (73.1%), myelodysplastic syndrome in 7 (6.5%), drug-induced thrombocytopenia in 7 (6.5%), and connective tissue disorder in 4 (3.7%) cases. Ten patients presented with intracranial bleedings. Upon logistic regression analysis, comorbidities in the form of essential hypertension and diabetes mellitus were significantly associated with occurrence of intracranial bleeding. There was no correlation of serious bleedings with platelet counts.
Isolated thrombocytopenia in the elderly is associated with significant morbidity. Diligent clinical and laboratory evaluation is required to elucidate the cause of thrombocytopenia in the elderly. Comorbidities in this population are associated with serious bleedings and not low platelet counts as is commonly thought.
血小板减少症在老年人中是一个重大问题。其病因不仅多种多样，还与显著的发病率和死亡率相关。我们开展了一项研究，以了解老年患者孤立性血小板减少症的病因，并将血小板减少症的严重程度和出血表现与各种病因及合并症相关联。
本研究纳入了108例年龄在50岁以上、表现为孤立性血小板减少症（血小板计数<100×10⁹/L，血红蛋白和白细胞总数正常）的患者。对每位患者进行了详细的病史询问和临床检查。通过自动血细胞计数器分析全血细胞计数。所有病例均检查外周血涂片。所有患者均采用酶联免疫吸附测定法进行乙肝表面抗原、抗丙型肝炎病毒和抗人类免疫缺陷病毒检测。根据临床指征，进行骨髓穿刺活检和细胞遗传学研究。
108例患者中，102例（94.4%）有出血倾向。29例（26.8%）出现严重（世界卫生组织3/4级）出血。主要发现为免疫性血小板减少性紫癜79例（73.1%）、骨髓增生异常综合征7例（6.5%）、药物性血小板减少症7例（6.5%）、结缔组织病4例（3.7%）。10例患者出现颅内出血。经逻辑回归分析，原发性高血压和糖尿病形式的合并症与颅内出血的发生显著相关。严重出血与血小板计数无相关性。
老年人孤立性血小板减少症与显著的发病率相关。需要进行细致的临床和实验室评估以阐明老年人血小板减少症的病因。该人群中的合并症与严重出血相关，而非如通常认为的与血小板计数低相关。
