Effectiveness and Reliability of Splenectomy in Chronic Immune Thrombocytopenia

Abstract

Although splenectomy is markedly effective treatment modality at early period in adult chronic immune thrombocytopenia (ITP), long-term outcomes are still controversial. The aim of this study was to determine long-term effectiveness and reliability of splenectomy in ITP and to identify factors influencing on long-term response. The study included 100 ITP patients who underwent splenectomy in our General Surgery Department between 1980 and 2004. Parameters including gender, age, platelet count, comorbid diseases, antiplatelet antibody positivity and long-term effect of medical treatment on response to splenectomy were considered. Owing to advances in treatment protocols, ITP has become a more benign disease and need for splenectomy has been decreased. However, splenectomy is a highly effective in second-line treatment. Based on our results, it was seen that open or laparoscopic splenectomy with low morbidity and mortality rates is an appropriate treatment modality for long-term control of chronic ITP in cases requiring splenectomy. Age and postoperative platelet count were identified as significant prognostic and predictive factors for long-term response to splenectomy.

Keywords

• Splenectomy
• treatment
• chronic immune thrombocytopenia

References

1. 1- Provan D, Newland A, Norfolk D, et al. Guidelines for the investigation and management of idiopathic thrombocytopenic purpura in adults, children and İn pregnancy. British Journal of Haematology 2003;20:574-596.
2. 2- Stasi R, Provan D. Management of Immune Thrombocytopenic Purpura İn Adults. Mayo Clin Proc 2004:79:504-522.
3. 3- Fogarty PF. Chronic immune thrombocytopenia in adults: epidemiology and clinical presentation. Hematol Oncol Clin North Am. 2009;23(6):1213-1221.
4. 4- Schoonen WM, Kucera G, Coalson J, et al. . Epidemiology of immune thrombocytopenic purpura in the general practice research database. Br J Haematol. 2009;145(2):235-244.
5. 5- Moulis G, Palmaro A, Montastruc JL, et al. Epidemiology of incident immune thrombocytopenia: a nationwide population-based study in France. Blood. 2014;124(22):3308-3315.
6. 6- George JN, Raskolo GE. İdiopathic thrombocytopenic purpura: A concise summary of the pathophysiology and diagnosis in children and adults. Semin Hematology 1998; 35:5-8.
7. 7- Shulman NR, Marder VJ, Weinrach RS. Similarities between known antiplatelet antibodies and the factor responsible for thrombocytopenia in idiopathic purpura. Physiologic, serologic and isotopic studies. Ann N Y Acad Sci. 1965;124(2):499-542.
8. 8- Khodadi E, Asnafi AA, Shahrabi S, et al. Bone marrow niche in immune thrombocytopenia: a focus on megakaryopoiesis. Ann Hematol. 2016;95(11):1765-1776.

9. 9- Olsson B, Andersson PO, Jernås M, et al. T-cell-mediated cytotoxicity toward platelets in chronic idiopathic thrombocytopenic purpura. Nat Med. 2003;9(9):1123-1124.
10. 10- A İsmet, K irfan, K Ernin, et al. Splenectomy results in patients with idiopathic thrombocytopenic purpura: 10 years of experience in Turgut Ozal Medical Center.Clin. Lab. Haematology 2004;26:211-214.
11. 11- Schvartz J, Leber MD, Gillis SI, et al. Long-term follow-up after splenectomy performed for immune thrombocytopenic purpura (ITP). American Journal of hematology 2003;72: 94-98.
12. 12- Beardsley DS. ITP in the 21st century. Hematology Am Soc Hematol Educ Program 2006: 402-407.
13. 13- Pamuk GE, Pamuk ÖN, Başlar Z, et al. Overview of 321 patients with idiopathic thrombocytopenic purpura. Retrospective analysis of the clinical features and response to therapy. Ann Hematol 2002; 81: 436-440.
14. 14- Vianelli N, Galh M, De Vivo A et al. Efficacy and safety of splenectomy in immune thrombocytopenic purpura: Long term results of 402 cases. The hematology journal 2005;90;72-77.
15. 15- Zoghlami Rintelen C, Weltermann A, Bittermann C, et al. Efficacy and safety of splenectomy in adult chronic immune thrombocytopenie:Ann Hematol 2003:82:290- 294.
16. 16- Cohen YC, Djulbegovlc B, Shamai-Lubovitz O, et al. The bleeding risk and natural history of idiopathic thrombocytopenic purpura in patients with persistent low platelet counts. Archives of Intemal Medicine 2000; 160:1630-1638.
17. 17- Velanovich V, Shurafa M. Laparoscopic excision of accessory spleen. Am J Surg 2000; 180: 62-64.
18. 18- The American Society of Hematology ITP Practice Guideline Panel. Diagnosis and treatment of idiopathic thrombocytopenic purpura: recommendations of the American Society of Hematology. Ann Intern Med 1997; 126: 319–326.
19. 19- Kojouri K, Vesely SK, Terrell DR, et al. Splenectomy for adult patients with idiopathic thrombocytopenic purpura: a systematic review to assess long-term platelet count responses, prediction of response, and surgical complications. Blood. 2004;104:2623-34.
20. 20- Drew Provan, Donald M. Arnold, James B. Bussel, et al. Updated international consensus report on the investigation and management of primary immune thrombocytopenia. Blood. 2019;3780-3817.
21. 21- Sara K Vesely, Jedidiah J. Perdue, Mujahıd A. Rizvi, et al. Management of Adult patients with Pesistent Idiapathic Thrombocytopenic Purpura Following Splenectomy: Annals of Internal Medicine 2004;140:2.
22. 22- Wu JM, Lai IR, Yuan RH, et al. Laparoscopic splenectomy for idiopathic thrombocytopenic purpura. Am J Surg. 2004;187:720-3.
23. 23- Portielje JE, Westendorp RG, Kluin-Nelemans HC, et al. Morbidity and mortality in adults wlth idiopathic thrombocytopenic purpura. Blood 2001; 97:2549-2554.
24. 24- Güneş l, Yılmazlar T, Sankaya l, et al. Scintigraphic detection of splenosis: supirority of tomografphic selective spleen scintigraphy. Clin Rad 1994; 49:115-117.
25. 25- Kinuya K, Matano S, Nakashima H, et al. Scintigrafphic Prediction of Therapeutic Outcomes of Splenectomy in Patients with Thrombocytopenia. Annals of Nuclear Medicine 2003;17(2):161-164.
26. 26- Fabris F, Tassan T, Ramon R. Age as the majör predictive factor of long-term response to splenectomy in immune thrombocytopenic purpura. British journal of haematology 2001;112:637-640.
27. 27- Chin Cheng Chen, Chao Hung Ho, Tzung Shian WJ. Predictive prognostic factors after splenectomy in patients with idiopathic thrombocytopenic purpura.Haematologica 2001;86:663-664.