Evaluation of Splenctomy Value in Patients with Autoimmune Cytopenic Purpura that Refer to Specialty Imam Reza Hospital between 2005-2015

Jalaeikhoo, H; Rajaeinejad, M; Kayhani, M; Shiravand, Y; Shahkarami, M; Shegarf, F

Evaluation of Splenctomy Value in Patients with Autoimmune Cytopenic Purpura that Refer to Specialty Imam Reza Hospital between 2005-2015

Document Type : Original Article

Authors

H Jalaeikhoo ¹

M Rajaeinejad ²

M Kayhani ³

Y Shiravand ⁴

M Shahkarami ⁵

F Shegarf ⁶

¹ Associate Professor of Hematology and Medical Oncology, AJA University of Medical Sciences and Health Services, AJA Cancer Research Center, Tehran, Iran

² Professor of Oncology and Hematology Department, Army University of Medical Sciences, Army Hospital 501

³ Professor, Department of Oncology and Hematology, Tehran University of Medical Sciences, Imam Khomeini Hospital (RA)

⁴ Master of Science in Hematology, Tehran University of Medical Sciences

⁵ Laboratory Science Expert, Army University of Medical Sciences

⁶ Master's degree and nursing instructor

Abstract

Introduction & Objective: Autoimmune cytopenic purpura (ITP) is a kind of disease accompanied with thrombocytopenia and platelet damage. The first line treatment is corticosteroid therapy, but always it's not effective. The aim of this study is find out the therapeutic value of splenctomy in these patients’s who that refers to speciality Immam Reza hospital between 2005-2015. Materials & Methods: In this study 88 patients with ITP who had undergone surgery for splenectomy were evaluated. We used a retrospective and clinical review method. The related data of gender, clinical signs, history of blood transfusion and treatment before splenectomy and patient condition after splenectomy are extracted and analyzed after codifying in SPSS 21 software and descriptive statistic. Results: The average age of the patients and those who had done splenectomzed were 39 years. The ratio of man to woman was equal. The results show that there is meaningful relationship between response to splenectomy and low age (P = 0.002) and also there is a meaningful relationship between using IVIG before splenectomy and rise platelet number after splenectomy (P = 0.004). Conclusions: Splenectomy, specialty using IVIG before that is good treatment for ITP.

Keywords

Splenectomy

Autoimmune Thrombocytopenic Purpura

IVIG

1. McMillan R. Chronic idiopathic thrombocytopenic purpura. N Eng J Med. 1981; 304: 1135.

2. Cines DB, Blanchette VS. Immune thrombocytopenic purpura. N Eng J Med. 2002; 346: 995-1008.

3. Fredriksen H, Schmidt K. The incidence of idiopathic thrombocytopenic purpura in adults increases with age. Blood 1999; 3: 909-913.

4. Lusher JM., Zueser WW., Idiopathic thrombocytopenic purpura in childhood. J pediatry 1966, 68: 971.

5. Platelet transfusion therapy. National institues of healt consensus development conference statement, 1986, oct 8, 6(7).

6. Lusher JM., Emami A., Karindranath Y., et al., Idiopathic thrombocytopenic purpura in children. Am J pediatr hematoloncol, 1984, 6: 149-57.

7. Portielje Je, Westendorp RG, Kluin-Nelmand HC, Brand A. Morbidity and mortality in adults with idiopathic thrombocytopenic purpura. Blood. 2001; 97: 2549-54.

8. George JN, Woolf SH, Raskob GE, et al. Idiopathic thrombocytopenic purpura: a practice guideline developed by explicit methods for the American Society of Hematology. Blood. 1996; 88: 3-40.

9. Kojouri K, Vesely SK, Terrell DR, George JN. Splenectomy for adult patients with idiopathic thrombocytopenic purpura: a systemic review to assess long-term platelet count responses, prediction of response, and surgical complication. Blood. 2004; 104: 2623-2634.

10. Udvardy M. [Immune thrombocytopenic purpura (ITP)]. Orvosi hetilap. 2001; 142(49):
2723-30.

11. Pavkovic, Marica, et al. "Long-Term
Follow-Up of Adult Patients with Idiopathic Thrombocytopenic Purpura after Splenectomy." Macedonian Journal of Medical Sciences 4.3 (2011): 285-289.

12. Fabris F, Tassan T, Ramon R, Carraro G, Randi ML, Luzzatto G, et al. Age as the majior predictive factor of long-term response to splenectomy in immune thrombocytopenic purpura. Br J Haematol 2001; 112: 637-40.

13. Di Fino SM, Lachant NA, Kirshner JJ, Gottlieb AJ. Adult idiopathic thrombocytopenic purpura. Clinical findings and response to therapy. Am J Med 1980; 69: 430-42.

14. Kumar S, Diehn FE, Gertz MA, Tefferi A. Splenectomy for immune thrombocytopenic purpura: long-term results and treatment of postsplenectomy relapses. Ann Hematol 2002; 81: 312-9.

15. Fenaux P, Caulier MT, Hirschauer MC, Beuscart R, Goudemand J, Bauters F. Revaluation of the prognostic factors for splenectomy in chronic idiopathic thrombocytopenic purpura (ITP): a report on 181 cases. Eur J Haematol 1989; 42: 259-64.

16. Gugliotta L, Isacchi G, Guarini A, Ciccone F, Motta MR, Lattarini C, et al. Chronic idiopathic thrombocytopenic purpura (ITP): site of platelet sequestration and results of splenectomy. A study of 197 patients. Scand J Haematol 1981; 26: 407-12.

17. Mintz SJ, Petersen SR, Cheson B, Cordell LJ, Richards RC. Splenectomy for immune thrombocytopenic purpura. Arch Surg 1981; 116: 645 50.

18. Rocco MV, Stein RS. Prognostic factors for splenectomy response in adult idiopathic thrombocytopenic Purpura. South Med J 1984; 77: 983 87.

19. Law C, Marcaccio M, Tam P, Heddle N, Kelton JG. High-dose intravenous immune globulin and the response to splenectomy in patients with idiopathic thrombocytopenic purpura. The New England journal of medicine. 1997 May 22; 336(21): 1494-8. Pub Med PMID: 9154768.

20. Choi CW, Kim BS, Seo JH, Shin SW, Kim YH, Kim JS, et al. Response to high-dose intravenous immune globulin as a valuable factor predicting the effect of splenectomy in chronic idiopathic thrombocytopenic purpura patients. American journal of hematology. 2001 Mar; 66(3): 197-202. Pub Med PMID: 11279626.

21. Khadijeh A, Parvaneh V, Marjan K. The response to the treatment of chronic idiopathic thrombocytopenic purpura in patients with splenectomy in hematology ward of Hazrat Ali Asghar (AS) during the years 1357 to 1378 in 1380. Iran University Medical Journal. No. 25.

22. Ramyar A, Kalantari N. Treatment of ITP, prednisolone versus IVIG: a 12month study in Children's Medical Center. Tehran University Medical Journal; Vol. 66, No. 1, Apr 2008: 34-37.

23. Berchtold P, Mcmillan R. Therapy of chronic idiopathic thrombocytopenic Purpura in adults. Blood 1989; 74: 2309-2317.

24. Shaw JHF, Clark MA. Splenectomy for immune thrombocytopenic purpura: Auckland experience 1979-87. Austr N Z J Surg 1990; 59:
123-126.

25. Fenaux P, Caulier MT, Hirshauer MC, Beuscart R, Goudemend J, Bauterrs F. Reevaluation of the prognostic factors for splenectomy in chronic idiopathic thrombocytopenic purpura: a report on 181 cases. Eur J Haematol 1989; 42: 259-264.