Document Detail


Durability and factors associated with long term response after splenectomy for primary immune thrombocytopenia (ITP) and outcome of relapsed or refractory patients.
MedLine Citation:
PMID:  20964585     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Splenectomy is the usual form of therapy for immune thrombocytopena (ITP) after steroid failure. We retrospectively studied the data in adult patients who underwent splenectomy for ITP from July 1996 to June 2008 to evaluate the long term responses, clinical and laboratory factors associated with long term responses and outcome of relapsed or refractory patients. Thirty eight patients, 30 (79%) females, with a median age of 23 years (range 15-69), underwent splenectomy. The procedure was laparoscopic in 28 (73.5%) and open in 10 patients. Splenectomy resulted in a response in 34/38 (89.5%) patients and failed in four (10.5%) patients. After a median follow-up of 58 months (range 7-144), 24 (63%) patients had a maintained response without treatment (platelet count of >50 × 10⁹)/l). Most of the relapses occurred during the first year but two patients had late relapses. There were procedure-related complications in seven (18.0%) patients but no cases of overwhelming sepsis. Only four relapsed or refractory patients had a platelet count below 50 × 10⁹/l at the last follow-up indicating response to alternative therapies. Responsiveness to steroids before the procedure (p = 0.025) along with a platelet count of ≥ 150 × 10⁹/l at 4 weeks (p = < 0.0001) and a highest platelet count of ≥ 400 × 10⁹/l at any time post-splenectomy (p = 0.005), were associated with a long term response in univariate analysis. In conclusion, splenectomy remains an effective treatment for ITP after steroid failure in terms of long term responses, and the majority of relapsed or refractory patients respond to alternative therapies.
Authors:
Aamer Aleem
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Publication Detail:
Type:  Journal Article     Date:  2010-10-22
Journal Detail:
Title:  Platelets     Volume:  22     ISSN:  1369-1635     ISO Abbreviation:  Platelets     Publication Date:  2011  
Date Detail:
Created Date:  2011-01-14     Completed Date:  2011-06-29     Revised Date:  2012-09-26    
Medline Journal Info:
Nlm Unique ID:  9208117     Medline TA:  Platelets     Country:  England    
Other Details:
Languages:  eng     Pagination:  1-7     Citation Subset:  IM    
Affiliation:
Department of Medicine, Division of Haematology/Oncology, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia. aameraleem@hotmail.com
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Chronic Disease
Female
Humans
Immunoglobulins, Intravenous / administration & dosage,  therapeutic use
Laparoscopy
Male
Middle Aged
Platelet Count
Prognosis
Purpura, Thrombocytopenic, Idiopathic / physiopathology,  surgery*,  therapy
Recurrence / prevention & control
Retrospective Studies
Splenectomy*
Steroids / administration & dosage,  therapeutic use
Time Factors
Treatment Outcome
Young Adult
Chemical
Reg. No./Substance:
0/Immunoglobulins, Intravenous; 0/Steroids

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