Idiopathic thrombocytopenic purpura in the older adult patient.

Forty adults with idiopathic thrombocytopenic purpura (ITP), aged over 45 years, were seen from March 1954 to December 1983 at the Medical College of Georgia. All patients had bleeding manifestations at presentation. Twenty-one of 40 (52.5%) during the follow-up period had either life-threatening or fatal bleeding episodes. There were no significant differences for the presence of any presenting clinical or laboratory feature for patients who achieved a complete remission compared with those who did not. A complete response to therapy, younger age, higher presenting hemoglobin level, and absence of central nervous system bleeding favorably influenced overall survival. Therapy was ineffective in this age group, with only 12 patients (30%) achieving a permanent complete remission. Fourteen patients (35%) died either from bleeding or from direct complications of therapy. This analysis of ITP in the older adult suggests a disease refractory to therapy that is associated with major morbidity and mortality.