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Itp splenectomy

Yue Guan, Shixuan Wang, Feng Xue, Xiaofan Liu, Lei Zhang, Huiyuan Li, Renchi Yang
OBJECTIVES: We performed this study in adult patients with chronic primary immune thrombocytopenia (ITP) to explore the long-term efficacy and safety of splenectomy. METHODS: Data of 174 patients who underwent splenectomy in our hospital from 1994 to 2014 were analyzed. RESULTS: After splenectomy, 126 (72.4%) patients achieved a complete response (CR) and 28 (16.1%) achieved a response (R). Thirty-two (20.8%) responders relapsed with a median time of 24 months...
October 18, 2016: European Journal of Haematology
Tao Xu, Ning Li, Fa Jin, Keren Wu, Zhipeng Ye
The study aimed to investigate the long-term outcomes of laparoscopic splenectomy (LS) in Chinese patients with chronic idiopathic thrombocytopenic purpura (ITP). This was a retrospective analysis of 114 patients with ITP who underwent LS from 2001 to 2013. Patients were classified according to response at last contact: complete response (CR), partial response (PR), and no response (NR). Patients with CR had the highest platelet levels and patients with NR had the lowest. A correlation was observed between postoperative peak platelet count and platelet count on 2-month postoperative (r=0...
October 2016: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques
Charbel Chater, Louis Terriou, Alain Duhamel, David Launay, Jean P Chambon, François R Pruvot, Moshe Rogosnitzky, Philippe Zerbib
INTRODUCTION: Corticosteroids are still the standard first-line treatment for immune thrombocytopenic purpura (ITP). As second-line therapy, splenectomy and Rituximab are both recommended. The aim of our study was to compare the efficacy of Rituximab to splenectomy in persistent or chronic ITP patients. METHODS: Between January 1999 and March 2015, we retrospectively selected all consecutive patients who underwent an ITP second-line treatment: Rituximab or splenectomy...
November 2016: Annals of Surgery
Reiko Watanabe, Takayuki Tabayashi, Tatsuki Tomikawa, Morihiko Sagawa, Tomoe Anan-Nemoto, Yuta Kimura, Yasuyuki Takahashi, Michihide Tokuhira, Satoshi Otaki, Hidenori Oi, Makoto Sawano, Satoshi Sugiyama, Masahiro Kizaki
Thrombopoietin receptor (TPO-R) agonists have been shown to be effective in refractory chronic immune thrombocytopenia (ITP); however, their efficacy in patients under critical care is not known. We report the case of a female patient with a newly diagnosed ITP who experienced severe bleeding from an external wound. The patient was administered the standard treatments for ITP, which are high-dose intravenous immunoglobulin (IVIg) and corticosteroids. However, following failure of these treatments, we administered romiplostim on day 6 after the onset of ITP...
October 5, 2016: International Journal of Hematology
Thomas Kühne
Evidence-based medicine is growing in immune thrombocytopenia (ITP), but solid clinical data are still lacking in many areas. A majority of children has self-limited ITP, but chronic symptomatic ITP exists also in pediatrics. Management includes a watch-and-wait strategy for children with newly diagnosed ITP and no or mild bleeding, and immunoglobulins and corticosteroids, if more bleeding and mucous membrane involvement is present. Treatment endpoints differ in clinical research and in clinical practice. The requirement of platelet enhancing drugs needs to be better defined in guidelines...
October 4, 2016: Hämostaseologie
George Vaos, Elpis Mantadakis, Stefanos Gardikis, Michael Pitiakoudis
We present a 7-year-old boy with recurrent thrombocytopenia after primary laparoscopic splenectomy for immune thrombocytopenia (ITP). Imaging modalities (ultrasound, computed tomography scan, and scintigraphy) revealed two accessory spleens while the subsequent second laparoscopy revealed 11, which were successfully removed. The relevant medical literature is reviewed, and the value of laparoscopy for chronic ITP is highlighted.
October 2016: Journal of Indian Association of Pediatric Surgeons
Dong Zheng, Chen-Song Huang, Shao-Bin Huang, Chao-Xu Zheng
Primary immune thrombocytopenia (ITP) is an immune-mediated disorder affecting both adults and children, characterised by bleeding complications and low platelet counts. Corticosteroids are the first-line therapy for ITP, but only 20%-40% of cases achieve a stable response. Splenectomy is the main therapy for patients failing to respond to corticosteroids for decades, and about two-thirds of patients achieve a long-lasting response. Although some new drugs are developed to treat ITP as second-line therapies in recent years, splenectomy is still the better choice with less cost and more efficiency...
September 16, 2016: World Journal of Gastrointestinal Endoscopy
Michael Steurer, Philippe Quittet, Helen A Papadaki, Dominik Selleslag, Jean-François Viallard, Georgia Kaiafa, Ann Janssens, Tomas Kozak, Hans Wadenvik, Marieke Schoonen, Laura Belton, Georg Kreuzbauer
OBJECTIVE: Romiplostim has maintained long-term platelet counts in patients with immune thrombocytopenia (ITP) for up to 5 years in clinical studies. This prospective observational study aimed to describe romiplostim utilisation and outcomes in European clinical practice. METHODS: Adults with primary ITP who received romiplostim in routine care were eligible. RESULTS: Three-hundred and forty patients were eligible for analysis, of whom 299 (88%) completed the two-year observation period...
August 25, 2016: European Journal of Haematology
Jose Perdomo
Romiplostim is a thrombopoietin receptor agonist (TPO-RA) used for the treatment of adult primary immune thrombocytopenia (ITP). ITP is an autoimmune condition characterized by low platelet counts due to increased destruction and reduced platelet production. First-line interventions include corticosteroids, anti-D, and intravenous immunoglobulins, while second-line therapies comprise splenectomy, rituximab, cyclosporine A, and TPO-RAs. The recognition that compromised platelet production is a critical part of the pathogenesis of ITP prompted the development of therapeutic strategies based on the stimulation of the TPO receptor...
2016: ImmunoTargets and Therapy
Anthony P Y Liu, Daniel K L Cheuk, Ana H Y Lee, Pamela P W Lee, Alan K S Chiang, S Y Ha, W C Tsoi, Godfrey C F Chan
Twenty percent of children with immune thrombocytopenia (ITP) develop a chronic course where treatment strategy is less established. Cyclosporin A (CSA) has been shown to be effective in small series of children with chronic ITP and might reduce the need for chronic steroid therapy and/or splenectomy. We reviewed consecutive patients below 18 years old with persistent or chronic ITP treated with CSA in our unit between January 1998 and June 2015. Thirty patients (14 boys and 16 girls) were included. The median age at initial diagnosis of ITP was 5 years (range 0...
October 2016: Annals of Hematology
Shosaku Nomura
Immune thrombocytopenia (ITP) is an acquired hemorrhagic condition characterized by the accelerated clearance of platelets caused by antiplatelet autoantibodies. A platelet count in peripheral blood <100 × 10(9)/L is the most important criterion for the diagnosis of ITP. However, the platelet count is not the sole diagnostic criterion, and the diagnosis of ITP is dependent on additional findings. ITP can be classified into three types, namely, acute, subchronic, and persistent, based on disease duration...
2016: Clinical Medicine Insights. Blood Disorders
Belén Martin Arnau, Víctor Turrado Rodriguez, Ernesto Tartaglia, Jesús Bollo Rodriguez, Eduardo M Targarona, Manuel Trias Folch
INTRODUCTION: Laparoscopic splenectomy (LS) is the preferred treatment of idiopathic thrombocytopenic purpura (ITP) when medical treatment fails. The objective was to evaluate the feasibility and safety of LS according to the preoperative platelet count. METHODS: This study is a retrospective analysis of a series of 199 patients who underwent LS for ITP from 1993 to 2015. The patients were divided into 3 groups according to platelet count: group i (<10×10(9)/L), group ii (10-50×10(9)/L) and group iii (> 50×10(9)/L)...
August 2016: Cirugía Española
Ivy Altomare, Karynsa Cetin, Sally Wetten, Jeffrey S Wasser
BACKGROUND: Immune thrombocytopenia (ITP) is a rare disorder characterized by low platelet counts and an increased tendency to bleed. The goal of ITP therapy is to treat or prevent bleeding. Actual rates of bleeding are unknown. Clinical trial data may not reflect real-world bleeding rates because of the inclusion of highly refractory patients and more frequent use of rescue therapy. METHODS: We used administrative medical claims data in the US to examine the occurrence of bleeding-related episodes (BREs) - a composite end point including bleeding and/or rescue therapy use - in adults diagnosed with primary ITP (2008-2012)...
2016: Clinical Epidemiology
Adam Cuker, Douglas B Cines, Cindy E Neunert
PURPOSE OF REVIEW: We address three current controversies in management of immune thrombocytopenia (ITP): Should asymptomatic children with newly diagnosed ITP and severe thrombocytopenia be treated? Does intensification of up-front therapy in adults with newly diagnosed ITP impact long-term outcomes? Is splenectomy still the second-line treatment of choice in adults with chronic ITP? RECENT FINDINGS: Severe bleeding is rare in children with ITP. There is little evidence that the platelet count predicts or that treatment prevents severe bleeding in this population...
September 2016: Current Opinion in Hematology
Rayaz Ahmed, Anup J Devasia, Auro Viswabandya, Kavitha M Lakshmi, Aby Abraham, Sampath Karl, John Mathai, Paul M Jacob, Deepak Abraham, Alok Srivastava, Vikram Mathews, Biju George
The purpose of this research is to study the outcomes of splenectomy for chronic and persistent immune thrombocytopenia (ITP). This study is a retrospective analysis of 254 patients with chronic or persistent ITP who underwent splenectomy at CMC, Vellore, India between 1995 and 2009. Responses were assessed based on standard criteria. One hundred and sixty seven adults and 87 children with a median age of 29 years (range 2-64) with persistent (n = 103) or chronic ITP (n = 151) was studied. Response was seen in 229 (90...
September 2016: Annals of Hematology
Matthieu Mahévas, Mathieu Gerfaud-Valentin, Guillaume Moulis, Louis Terriou, Sylvain Audia, Sophie Guenin, Guillaume Le Guenno, Gilles Salles, Olivier Lambotte, Nicolas Limal, Jean-François Viallard, Stephane Cheze, Cecile Tomowiak, Bruno Royer, Antoine Neel, Odile Debouverie, Arnaud Hot, Isabelle Durieu, Antoinette Perlat, Manuel Cliquennois, Clémence Deteix, Marc Michel, Bertrand Godeau
Refractory immune thrombocytopenia (ITP) was previously defined as lack of a minimum response to splenectomy and the requirement for long-term treatment to reduce the risk of significant bleeding events. In this multicenter study, we included 37 patients with multirefractory ITP, defined as no response to splenectomy, rituximab, romiplostim, and eltrombopag. As compared with a historical cohort of 183 ITP patients, matched on the calendar year of ITP diagnosis with a 5:1 ratio, patients with multirefractory ITP were more likely to have secondary ITP (odds ratio [OR], 4...
September 22, 2016: Blood
Abrar-Ahmad Zulfiqar, Jean-Luc Novella, Rachid Mahmoudi, Jean-Loup Pennaforte, Emmanuel Andres
There are no specific recommendations on the care of elderly patients with ITP. A retrospective study over two academic centers (Reims and Strasbourg), focused on patients over 65 who have been diagnosed idiopathic thrombocytopenic purpura in two unit of internal medicine. 41 patients were enrolled, including 27 women (66%). The median age is 76.75 years. On admission, the average thrombocytopenia is 34.45 G/L; 24 patients (58.5%) showed severe bleeding mucosal and/or visceral signs; 37 patients (90%) had a first-line treatment...
June 1, 2016: Gériatrie et Psychologie Neuropsychiatrie du Vieillissement
Ruta Arays, Sahil Goyal, Kim M Jordan
Common variable immunodeficiency (CVID) is readily considered in patients presenting with recurrent sino-pulmonary infections, however this disease has a broad range of clinical manifestations and diagnosis can be delayed by several years. We present the case of a 44-year-old postpartum female who presented with nausea, vomiting and abdominal distension. Four years prior, she was hospitalized for treatment of immune thrombocytopenia (ITP) with splenectomy and rituximab followed by two episodes of bacterial meningitis despite immunizations...
August 2016: Postgraduate Medicine
Ying Li, Dawei Zhang, Fanli Hua, Song Gao, Yangjiong Wu, Jianmin Xu
OBJECTIVE: To assess the effect and complications of open splenectomy (OS) for immune thrombocytopenic purpura (ITP) and determine preoperative factors associated with surgical effect. METHODS: This was a retrospective analysis of ITP patients who failed medical therapy and were treated with OS between 1997 and 2014 at the Jinshan Hospital, China. Follow-up was 60 months. Surgical effect was determined from platelet counts and bleeding episodes. Complications were assessed including bleeding episodes...
June 1, 2016: European Journal of Haematology
Indraraj Umesh Doobaree, Raghava Nandigam, Dimitri Bennett, Adrian Newland, Drew Provan
Adults with primary immune thrombocytopenia (ITP) may be susceptible to thromboembolism (TE). The objective of this systematic review was to evaluate studies that reported the prevalence and risk of developing TE in the ITP population from ITP diagnosis and splenectomy. We searched several bibliographic databases and included 29 studies. Using meta-analytical techniques, the pooled prevalence of TE before ITP diagnosis was 7.84% (arterial 6.25%; venous 1.95%). The pooled 'annualised' cumulative incidence (without prior TE) and cumulative risk (irrespective of prior TE) were 1...
October 2016: European Journal of Haematology
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