P647 Idiopathic Thrombocytopenic Purpura associated with Inflammatory Bowel Disease: a multi-centre ECCO CONFER case series
Mahajna , H.(1);Verstockt , B.(2);Bergemalm , D.(3);Castiglione , F.(4);Rodríguez-Moranta , F.(5);Vincenzo Savarino , E.(6);Hoentjen , F.(7,8);Bessissow , T.(9);Pokryszka , J.(10);Cremer , A.(11);Eder , P.(12);Truyens , M.(13);Yershalmy-Feler , A.(14);García , M.J.(15);Kopylov , U.(1);
(1)Sheba Medical Center, Department of Gastoenterology, Ramat Gan, Israel;(2)University Hospitals Leuven, Department of Gastroenterology and Hepatology- Department of Chronic Diseases and Metabolism, Leuven, Belgium;(3)Faculty of Medicine and Health- Örebro University, Department of Gastroenterology, Örebro, Sweden;(4)University Federico II of Naples, Gastroenterology- Department of Clinical Medicine and Surgery, Naples, Italy;(5)Bellvitge University Hospital- Hospitalet de Llobregat, Gastroenterology Department, Barcelona, Spain;(6)University of Padua, Department of Surgery- Oncology and Gastroenterology- DISCOG, Padua, Italy;(7)University of Alberta, Division of Gastroenterology- Department of Medicine, Edmonton, Canada;(8)Radboud University Medical Center, Department of Gastroenterology and Hepatology, Nijmegen, The Netherlands;(9)McGill University Health Center, Division of Gastroenterology- Department of Medicine, Montreal, Canada;(10)Medical University of Vienna, Department of Internal Medicine III- Division of Gastroenterology and Hepatology, Vienna, Austria;(11)Erasme University Hospital, Department of Gastroenterology, Brussels, Belgium;(12)Poznan University of Medical Sciences, Department of Gastroenterology- Dietetics and Internal Diseases, Poznan, Poland;(13)Ghent University Hospital, Department of Gastroenterology, Ghent, Belgium;(14)"Dana-Dwek" Children's Hospital- Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine- Tel Aviv University, Pediatric Gastroenterology Institute, Tel-Aviv, Israel;(15)Hospital Universitario Marqués de Valdecilla- IDIVAL- Universidad de Cantabria, Gastroenterology Department, Santander, Spain;
Background
Idiopathic Thrombocytopenic Purpura (ITP) is an acquired haematological disorder with an incidence of 1 to 6 per 100.000, with reported comorbidity in patients with Inflammatory Bowel Disease (IBD). The current study aimed to evaluate the clinical presentation and outcome of ITP in IBD patients.
Methods
This multicenter retrospective case series was performed as part of the ECCO Collaborative Network of Exceptionally Rare case reports (CONFER) project. Cases of patients with ITP and IBD were collected by participating investigators. Clinical data were recorded in a standardised collection form.
Results
This report includes 20 patients with concurrent ITP and IBD: 15 were males, median age was 34 [Interquartile range (IQR) 25-56]. 12 subjects had a diagnosis of ulcerative colitis and 8 of Crohn’s disease. The diagnosis of IBD preceded the ITP diagnosis in 17 patients (median time between diagnosis was 7 years [IQR 1-14 years]). Among those, 10 patients were in IBD clinical remission at ITP diagnosis. Nine were treated with mesalamine, one with thiopurine, 4 with tumor necrosis factor-alpha (TNF) blockers, and 3 with no treatment. The mean platelet count at the presentation of ITP was 41.7±38.6 × 109/L. 6 patients had rectal bleeding, 8 had purpura, 6 had mucosal petechia, 2 had epistaxis, and 6 patients were asymptomatic. Regarding ITP treatment, 11 were treated with corticosteroids, 1 with Anti-RhD immunoglobulin, 7 with intravenous immunoglobulins (IVIG), 2 with rituximab and 2 patients eventually required splenectomy. All patients whose first presentation of ITP was rectal bleeding were treated medically with successful control of the ITP and IBD, None of them required splenectomy. 3 patients required colectomy with long-term follow-up, indicated by the IBD and not due to massive bleeding as a complication of ITP. With long-term follow-up, all patients had thrombocytes count above 50 × 109/L , and 18 were in IBD clinical remission.
Conclusion
Most ITP cases in this case series occurred after the IBD diagnosis and responded well to regular ITP treatment. The course of the ITP in the IBD patients follows a regular course, including response to medical therapy and low rates of splenectomy.