Recurrence in immune thrombocytopenic purpura after splenectomy

Yıl 2012, Cilt: 18 Sayı: 2, 52 - 55, 01.03.2012

Sedat Tan Mehmet Görgün Cezmi Karaca Eyüp Kebapçı Ayça Tan

Öz

In our study, we aimed to evaluate and discuss the recurrence rate and the causes for recurrences in splenectomy due to immune thrombocytopenic purpura. Thirty-six patients who had splenectomy due to immune thrombocytopenic purpura, enrolled in the study. Patients were evaluated for age and gender. Twenty-five patients were followed at a mean of 24 months. Recurrence rate and causes for recurrences; laparoscopic or open surgery, gender, age, preoperative and postoperative 2nd day platelet count were evaluated and discussed with the data in the literature. Thirteen patients (36.1%) were male and 23 patients (63.9%) patients were female. Mean age was 37,7. Accessory spleen was found in 4 patients (11.1%). In the follow-up of 25 patients, 5 patients (20%) had recurrence, 1 patient (4%) had partial recurrence. Although the recurrence rate was higher in woman and over 40 year old group, this was not statistically significant. The recurrence rate of patients, whose platelet count below 156.000/ml in postoperatively 2nd day, was significantly more than the patients whose platelet count above this value (p=0,024). Even under the best conditions, it is not possible to completely avoid the recurrences in surgical treatment of immune thrombocytopenic purpura. Therefore, we think it would be helpful to identify the patients with postoperatively 2nd day platelet count who have possibility for recurrence and keep those under control more often.

Anahtar Kelimeler

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İmmun trombositopenik purpurada splenektomi sonrası yineleme

Öz

Çalışmamızda, immun trombositopenik purpura nedeniyle splenektomi yapılan hastalarda, yineleme oranı ve buna etki eden nedenleri değerlendirip sonuçları literatür eşliğinde tartışmayı amaçladık. İmmun trombositopenik purpura nedeni ile splenektomi yapılan 36 hasta çalışma kapsamına alındı. Hastalar yaş ve cinsiyet yönünden değerlendirildi. Takipli olan 25 hasta ortalama 24 ay izlendi. Yineleme oranı ve buna etki edebilecek nedenler olarak ameliyatın açık veya kapalı olması, cinsiyet, yaş, ameliyat öncesi ve sonrası 2. gün trombosit değerleri değerlendirilerek literatür eşliğinde tartışıldı. On üç hasta (%36,1) erkek, 23 hasta (% 63,9) hasta kadın idi. Ortalama yaş 37,7 idi. Aksesuar dalak 4 hastada (%11,1) bulundu. İzlenen 25 hastanın, 5’inde (%20) yineleme, 1’inde (%4) ise parsiyel yineleme saptandı. Kadınlarda ve 40 yaş üzerindekilerde yineleme oranı fazla olsa da istatistiksel olarak anlamlı değildi. Ameliyat sonrası 2. gün alınan trombosit değeri 156000/ml altında olanlarda, bu değerin üstünde olanlara göre yineleme oranı fazla ve istatistiksel olarak anlamlı idi (p=0,024). İmmun trombositopenik purpura cerrahi tedavisinde yinelemeyi tamamen önlemek en iyi şartlarda dahi mümkün olamamaktadır. Bu nedenle ameliyat sonrası 2. gün alınan trombosit değerleri ile yineleme olabilecek hastaları saptayıp daha sık kontrol altında tutmanın yerinde olacağını düşünmekteyiz.

Anahtar Kelimeler

İmmun trombositopenik purpura, nüks, splenektomi, yineleme

Kaynakça

• 1. Berchtold P, McMillan R. Therapy of chronic idiopathic thrombocytopenic purpura in adults. Blood 1989;74(7):2309-17.
• 2. Bussel J, Cines, D. Immune thrombocytopenic purpura, neonatal alloimmune thrombocytopenia and post-transfusion purpura. In: Hoffman RBE, Shattil S, Furie B, Cohen HJ, Silberstein LE, McGlave P, ed. Hematology Basic Principles and Practice. New York: Churchill Livingstone; 2000:2096- 2114.
• 3. Schwartz J, Leber MD, Gillis S, Giunta A, Eldor A, Bussel JB. Long term follow-up after splenectomy performed for immune thrombocytopenic purpura (ITP). Am J Hematol 2003;72(2):94- 8.
• 4. Akwari OE, Itani KM, Coleman RE, Rosse WF. Splenectomy for primary and recurrent immune thrombocytopenic purpura (ITP). Current criteria for patient selection and results. Ann Surg 1987;206(4):529-41.
• 5. Fenaux P, Caulier MT, Hirschauer MC, Beuscart R, Goudemand J, Bauters F. Reevaluation of the prognostic factors for splenectomy in chronic idiopathic thrombocytopenic purpura (ITP): a report on 181 cases. Eur J Haematol 1989;42(3):259- 64.
• 6. Mazzucconi MG, Arista MC, Peraino M, Chistolini A, Felici C, Francavilla V, et al. Long-term follow-up of autoimmune thrombocytopenic purpura (ATP) patients submitted to splenectomy. Eur J Haematol 1999;62(4):219-22.
• 7. Naouri A, Feghali B, Chabal J, Boulez J, Dechavanne M, Viala JJ, et al. Results of splenectomy for idiopathic thrombocytopenic purpura. Review of 72 cases. Acta Haematol 1993;89(4):200-3.
• 8. Pizzuto J, Ambriz R. Therapeutic experience on 934 adults with idiopathic thrombocytopenic purpura: Multicentric Trial of the Cooperative Latin American group on Hemostasis and Thrombosis. Blood 1984;64(6):1179-83.
• 9. Shaw JH, Clark MA. Splenectomy for immune thrombocytopenic purpura: Auckland experience 1979-87. Aust N Z J Surg 1989;59(2):123-6 (Erratum in: Aust N Z J Surg 1989;59(5):442).
• 10. George JN, Woolf SH, Raskob GE, Wasser JS, Aledort LM, Ballem PJ, et al. Idiopathic thrombocytopenic purpura: a practice guideline developed by explicit methods for the American Society of Hematology. Blood 1996;88(1):3-40.
• 11. Portielje JE, Westendorp RG, Kluin-Nelemans HC, Brand A. Morbidity and mortality in adults with idiopathic thrombocytopenic purpura. Blood 2001;97(9):2549-54.
• 12. Cordera F, Long KH, Nagorney DM, McMurtry EK, Schleck C, Ilstrup D, et al. Open versus laparoscopic splenectomy for idiopathic thrombocytopenic purpura: clinical and economic analysis. Surgery 2003;134(1):45-52.
• 13. Harrington WJ, Minnich V, Hollingsworth JW, Moore CV. Demonstration of a thrombocytopenic factor in the blood of patients with thrombocytopenic purpura. J Lab Clin Med 1951;38(1):1-10.
• 14. Dameshek W, Rubio F Jr, Mahoney JP, Reeves WH, Burgin LA. Treatment of idiopathic thrombocytopenic purpura (ITP) with prednisone. J Am Med Assoc 1958;166(15):1805-15.
• 15. Katkhouda N, Manhas S, Umbach TW, Kaiser AM. Laparoscopic splenectomy. J Laparoendosc Adv Surg Tech A 2001;11(6):383-90.
• 16. Kaznelson P. Verschwinden der hamorrhagischen Diathese bei einem Falle von essentieller Thrombopenie (frank) nach Milzexstirpation: Splenogene thrombolytische purpura. Wien Klin Wochenschr 1916;29:1451.
• 17. George JN, el-Harake MA, Raskob GE. Chronic idiopathic thrombocytopenic purpura. N Engl J Med 1994;331(18):1207- 11.
• 18. Karpatkin S. Autoimmune (idiopathic) thrombocytopenic purpura. Lancet 1997;349(9064):1531-6.
• 19. Pamuk GE, Pamuk ON, Baslar Z, Ongoren S, Soysal T, Ferhanoglu B, et al. Overview of 321 patients with idiopathic thrombocytopenic purpura. Retrospective analysis of the clinical features and response to therapy. Ann Hematol 2002;81(8):436- 40.
• 20. DiFino SM, Lachant NA, Kirshner JJ, Gottlieb AJ. Adult idiopathic thrombocytopenic purpura. Clinical findings and response to therapy. Am J Med 1980;69(3):430-42.
• 21. Stasi R, Stipa E, Masi M, Cecconi M, Scimo MT, Oliva F, et al. Long-term observation of 208 adults with chronic idiopathic thrombocytopenic purpura. Am J Med 1995;98(5):436-42.
• 22. Katkhouda N, Mavor E. Laparoscopic splenectomy. Surg Clin North Am 2000;80(4):1285-97.
• 23. Shimomatsuya T, Horiuchi T. Laparoscopic splenectomy for treatment of patients with idiopathic thrombocytopenic purpura. Comparison with open splenectomy. Surg Endosc 1999;13(6):563-6
• 24. Amaral JF, Meltzer RC, Crowley JP. Laparoscopic accessory splenectomy for recurrent idiopathic thrombocytopenic purpura. Surg Laparosc Endosc 1997;7(4):340-4.
• 25. George JN, Kojouri K, Perdue JJ, Vesely SK. Management of patients with chronic, refractory idiopathic thrombocytopenic purpura. Semin Hematol 2000;37(3):290-8.
• 26. Julia A, Araguas C, Rossello J, Bueno J, Domenech P, Olona M, et al. Lack of useful clinical predictors of response to splenectomy in patients with chronic idiopathic thrombocytopenic purpura. Br J Haematol 1990;76(2):250-5.
• 27. Fabris F, Tassan T, Ramon R, Carraro G, Randi ML, Luzzatto G, et al. Age as the major predictive factor of long-term response to splenectomy in immune thrombocytopenic purpura. Br J Haematol 2001;112(3):637-40.