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Itp splenectomy

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https://www.readbyqxmd.com/read/29332223/long-term-efficacy-of-partial-splenic-embolization-for-the-treatment-of-steroid-resistant-chronic-immune-thrombocytopenia
#1
Emi Togasaki, Naomi Shimizu, Yuhei Nagao, Chika Kawajiri-Manako, Ryoh Shimizu, Nagisa Oshima-Hasegawa, Tomoya Muto, Shokichi Tsukamoto, Shio Mitsukawa, Yusuke Takeda, Naoya Mimura, Chikako Ohwada, Masahiro Takeuchi, Emiko Sakaida, Tohru Iseki, Hideyuki Yoshitomi, Masayuki Ohtsuka, Masaru Miyazaki, Chiaki Nakaseko
Thrombopoietin-receptor agonists have been recently introduced for a second-line treatment of immune thrombocytopenia (ITP). Splenectomy has tended to be avoided because of its complications, but the response rate of splenectomy is 60-80% and it has still been considered for steroid-refractory ITP. We performed partial splenic embolization (PSE) as an alternative to splenectomy. Between 1988 and 2013, 91 patients with steroid-resistant ITP underwent PSE at our hospital, and we retrospectively analyzed the efficacy and long-term outcomes of PSE...
January 13, 2018: Annals of Hematology
https://www.readbyqxmd.com/read/29297977/the-association-between-idiopathic-thrombocytopenic-purpura-and-cardiovascular-disease-a-retrospective-cohort-study
#2
J S Chandan, T Thomas, S Lee, T Marshall, B Willis, K Nirantharakumar, P Gill
Essentials We estimated the cardiovascular risk of patients with idiopathic thrombocytopenic purpura (ITP). The risk of cardiovascular disease was 38% higher in ITP patients compared with controls. Among the ITP patients, splenectomy was associated with higher cardiovascular disease. Clinicians should consider cardiovascular risk when managing ITP patients. SUMMARY: Background Idiopathic thrombocytopenic purpura (ITP) is classically characterized by a transient or persistent decrease of platelet count...
January 3, 2018: Journal of Thrombosis and Haemostasis: JTH
https://www.readbyqxmd.com/read/29295846/splenectomy-for-immune-thrombocytopenia-down-but-not-out
#3
Shruti Chaturvedi, Donald M/ Arnold, Keith R McCrae
Splenectomy is an effective therapy for steroid-refractory or dependent immune thrombocytopenia (ITP). With the advent of medical alternatives such as rituximab and thrombopoietin receptor antagonists (TPO-RA), the use of splenectomy has declined and is generally reserved for patients that fail multiple medical therapies. Splenectomy removes the primary site of platelet clearance and autoantibody production, and offers the highest rate of durable response (50-70%) compared to other ITP therapies. However, there are no reliable predictors of splenectomy response, and long-term risks of infection and cardiovascular complications must be considered...
January 2, 2018: Blood
https://www.readbyqxmd.com/read/29243329/thrombopoietin-receptor-agonists-in-patients-with-persistent-or-chronic-immune-thrombocytopenia
#4
Jacopo Agnelli Giacchello, Federica Valeri, Mario Boccadoro, Alessandra Borchiellini
OBJECTIVES: To assess long-term treatment patterns and outcomes in patients with persistent or chronic immune thrombocytopenia (ITP), also considering the impact of the treatment with thrombopoietin receptor agonists (TPO-RAs) prior to splenectomy. METHODS: Medical records of all patients with persistent or chronic ITP seen at our institution between January 1985 and December 2016 were reviewed. Data on demographic and clinical characteristics were analyzed using descriptive statistics...
December 15, 2017: European Journal of Haematology
https://www.readbyqxmd.com/read/29200102/adult-primary-immune-thrombocytopenia-spleen-histology-findings-and-outcomes-according-to-rituximab-use-based-on-analysis-of-41-cases
#5
Adeline Furudoï, Étienne Rivière, Estibaliz Lazaro, Enio Furudoï, Jean-François Viallard, Marie Parrens
Immune thrombocytopenia (ITP) is an acquired antibody-mediated disease, for which splenectomy remains a curative treatment. We analyzed histology and phenotypes of ITP-splenectomy specimens from 41 adult patients, with different previous ITP-specific treatments, including B-cell-depleting rituximab (RTX) or not, in an attempt to predict splenectomy success or failure on the basis of day 56 postoperative platelet counts. RTX-naive ITP-spleen samples, compared with those from a 20-patient control trauma cohort, contained the following nonspecific, ITP-evocative, white-pulp lesions: follicular helper T-cell (programmed death-1 and inducible T-cell COStimulator) expansion in reactive follicles (P=0...
December 1, 2017: American Journal of Surgical Pathology
https://www.readbyqxmd.com/read/29188582/a-low-birth-weight-infant-with-no-malformations-delivered-by-a-primary-immune-thrombocytopenia-patient-treated-with-eltrombopag
#6
Naruko Suzuki, Junji Hiraga, Yumi Hariyama, Yusuke Takagi, Haruhiko Ohashi, Yasuyuki Kishigami, Hidenori Oguchi, Yoshitoyo Kagami
Primary immune thrombocytopenia (ITP) is defined by a low platelet count secondary to antibody-mediated platelet destruction or reductions in platelet production. Although eltrombopag is a thrombopoietin receptor agonist that increases platelet production in refractory or relapsed ITP, the influence on pregnancy is limited. We present the case of a pregnant 25-year-old ITP patient referred to our hospital with a history of two induced abortions. After eradication of Helicobacter pylori and with oral prednisolone at 8 mg/day, platelet count remained below 10,000/µl...
November 29, 2017: International Journal of Hematology
https://www.readbyqxmd.com/read/29101508/a-sticky-situation-myocardial-infarction-in-a-young-woman-with-immune-thrombocytopenia-on-eltrombopag-and-a-history-of-mediastinal-radiation
#7
Jennifer Teichman, Ahmed Taher, Abdulaziz Hashi, Akshay Bagai, Michelle Sholzberg
More recent immune thrombocytopenia (ITP) treatment strategies enhance platelet production with the use of thrombopoietin receptor agonists (TPO-RA) such as eltrombopag. Patients receiving TPO-RA agents may be at an increased risk of thromboembolism, however the pathophysiology and common underlying risk factors are not well understood. We present the case of a young asplenic woman on eltrombopag for chronic ITP with acute myocardial infarction involving the right coronary artery. Past medical history was significant for remote mediastinal radiation for lymphoma and splenectomy for ITP...
November 3, 2017: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/29090586/diagnosis-and-treatment-of-myh9-rd-in-an-australasian-cohort-with-thrombocytopenia
#8
David J Rabbolini, Yenna Chun, Maya Latimer, Shinji Kunishima, Kathleen Fixter, Bhavia Valecha, Peter Tan, Lee Ping Chew, Benjamin T Kile, Rachel Burt, Kottayam Radhakrishnan, Robert Bird, Paul Ockelford, Sara Gabrielli, Qiang Chen, William S Stevenson, Christopher M Ward, Marie-Christine Morel-Kopp
MYH9-related disorders (MYH9-RDs) caused by mutation of the MYH9 gene which encodes non-muscle myosin heavy-chain-IIA (NMMHC-IIA), an important motor protein in hemopoietic cells, are the most commonly encountered cause of inherited macrothrombocytopenia. Despite distinguishing features including an autosomal dominant mode of inheritance, giant platelets on the peripheral blood film accompanied by leucocytes with cytoplasmic inclusion bodies (döhle-like bodies), these disorders remain generally under-recognized and often misdiagnosed as immune thrombocytopenia (ITP)...
November 1, 2017: Platelets
https://www.readbyqxmd.com/read/29075074/percentage-of-memory-b-lymphocytes-and-regulatory-t-lymphocytes-in-peripheral-blood-are-low-but-not-predictive-of-therapy-outcomes-in-newly-diagnosed-adult-patients-with-primary-immune-thrombocytopenia
#9
Mustafa Yilmaz, Semiha Ayhan
Although changes in the number and function of regulatory T lymphocytes have been reported in primary immune thrombocytopenia (ITP), no study has investigated whether quantification of these cell types in peripheral blood could be used as early predictive marker of treatment outcome. And, it is not clear whether any change occurs in peripheral blood memory B lymphocyte levels in ITP. Hence, the aim of this study was to investigate the percentage of regulatory T lymphocytes and memory B lymphocytes in peripheral blood of ITP patients compared to controls, and also examine whether these levels have any significant predictive value for therapy outcome...
December 2017: Indian Journal of Hematology & Blood Transfusion
https://www.readbyqxmd.com/read/29075071/low-dose-rituximab-in-chronic-itp-still-an-option-in-resource-limited-settings
#10
Rajan Kapoor, Rajiv Kumar, M Mahapatra, H P Pati, Suman Kumar Pramanik
The etiology of ITP remains unknown but its pathogenesis consists of loss of tolerance to platelet antigens. There is a complex dysregulation of the immune system involving both the B cells and the T cells. Splenectomy is the standard second line option in steroid refractory chronic ITP patients. However, costs of surgery and reluctance for surgery in severely thrombocytopenic patients on part of surgeons are major obstacles in resource limited settings. Rituximab has been used in both the standard doses of 375 mg/m(2) and low doses of 100 mg/m(2) with similar results...
December 2017: Indian Journal of Hematology & Blood Transfusion
https://www.readbyqxmd.com/read/29042367/safety-and-efficacy-of-long-term-treatment-of-chronic-persistent-itp-with-eltrombopag-final-results-of-the-extend-study
#11
Raymond S M Wong, Mansoor N Saleh, Abderrahim Khelif, Abdulgabar Salama, Maria Socorro O Portella, Paul Burgess, James B Bussel
In phase 2/3 trials, eltrombopag treatment of 6 months or less in patients with chronic/persistent immune thrombocytopenia (ITP) increased platelet counts and reduced bleeding. The open-label EXTEND study evaluated long-term safety and efficacy of eltrombopag in adults with ITP who had completed a previous eltrombopag study. For the 302 patients enrolled, median duration of eltrombopag treatment was 2.37 years (2 days-8.76 years). Median platelet counts increased to 50 × 10 9 /L or more by week 2 and were sustained throughout the treatment period...
December 7, 2017: Blood
https://www.readbyqxmd.com/read/28967793/fostamatinib-for-persistent-chronic-adult-immune-thrombocytopenia
#12
Adrian Newland, Eun-Ju Lee, Vickie McDonald, James B Bussel
Immune thrombocytopenia (ITP) is an acquired autoimmune disorder characterized by phagocytosis and destruction of autoantibody-coated platelets via spleen tyrosine kinase (Syk)-mediated signal transduction in macrophages. Effectiveness of existing therapies varies, and even leading treatments (e.g., IVIg, splenectomy, rituximab, thrombopoietic agents) do not provide optimal management for a substantial number of patients with chronic ITP. Fostamatinib disodium is an orally-bioavailable investigational agent being developed for treatment of primary persistent/chronic adult ITP...
October 2, 2017: Immunotherapy
https://www.readbyqxmd.com/read/28952075/persistent-changes-in-circulating-white-blood-cell-populations-after-splenectomy
#13
Minke A E Rab, Aafke Meerveld-Eggink, Heleen van Velzen-Blad, Douwe van Loon, Ger T Rijkers, Okke de Weerdt
The effect of splenectomy on the incidence of infections and thromboembolisms has been investigated thoroughly. Nevertheless, the long-term effects of splenectomy on immunological profile and circulating blood counts have not been described before. To study such long-term effects, we analysed several parameters in splenectomised trauma patients and compared the results of this group ("otherwise healthy patients") to patients with a specific underlying disease. We measured platelet count, leukocytes and differential, lymphocyte subsets, serum levels of immunoglobulins, and complement pathways in 113 patients...
September 26, 2017: International Journal of Hematology
https://www.readbyqxmd.com/read/28906353/immunomodulatory-treatments-for-persistent-and-chronic-immune-thrombocytopenic-purpura-a-prisma-compliant-systematic-review-and-meta-analysis-of-28-studies
#14
REVIEW
Emmanuelle Weber, Quitterie Reynaud, Romain Fort, Stéphane Durupt, Pascal Cathébras, Isabelle Durieu, Jean-Christophe Lega
BACKGROUND: Corticosteroid sparing is required in 15% to 40% of adults with persistent or chronic primary immune thrombocytopenic purpura (ITP). Herein, the efficacy of immunomodulatory drugs (dapsone, interferon alpha, danazol, and hydroxychloroquine as second-third-line therapies in ITP is investigated. METHODS: MEDLINE was searched for studies that included patients with persistent or chronic primary ITP and published before the end of December 2014. Two investigators independently extracted data regarding study design, patient characteristics, dosage schedule, time to response, and occurrence of adverse events...
September 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28895035/splenectomy-vs-rituximab-as-a-second-line-therapy-in-immune-thrombocytopenic-purpura-a-single-center-experience
#15
Ahmed S Al Askar, Naila A Shaheen, Mohsen Al Zahrani, Mohammed G Al Otaibi, Bader S Al Qahtani, Faris Ahmed, Mohand Al Zughaibi, Ismat Kamran, May Anne Mendoza, Altaf Khan
Immune thrombocytopenic purpura (ITP) is a common hematological disease treated primarily by corticosteroids. The aim of the present study was to compare response rate between patients, underwent splenectomy vs. rituximab as second-line therapy. Adult patients diagnosed with ITP who did not respond to corticosteroids or relapsed during the period 1990-2014 were included in a quasi-experimental study. Categorical variables were compared using Fisher exact test. Response to treatment was compared using logistic regression...
September 11, 2017: International Journal of Hematology
https://www.readbyqxmd.com/read/28770876/assessment-of-the-underlying-causes-of-the-immune-thrombocytopenia-ten-years-experience
#16
Mehmet Sinan Dal, Abdullah Karakus, Tuba Dal, Berrin Balik Aydin, Elif Hattapoglu, Mehmet Onder Ekmen, Turgay Ulas, Orhan Ayyildiz
OBJECTIVE: Immune thrombocytopenia (ITP) is an immune haematologic disorder causing platelet destruction mediated by anti-platelet antibodies. In this study we aimed to evaluate the clinical and laboratory variables of ITP patients in southeast of Turkey. METHODS: In this retrospective study 167 ITP patients between 2005 and 2015 were evaluated. All patients were screened for immunological parameters including ANA (antinuclear antibodies), anti dsDNA (anti-double-stranded-DNA), ACA(anti-cardiolipin) IgM and IgG, LA (lupus anticoagulants)...
July 2017: JPMA. the Journal of the Pakistan Medical Association
https://www.readbyqxmd.com/read/28748715/rate-of-bleeding-related-episodes-in-elderly-patients-with-primary-immune-thrombocytopenia-a-retrospective-cohort-study
#17
Shuling Li, Julia T Molony, Karynsa Cetin, Jeffrey S Wasser, Ivy Altomare
OBJECTIVE: Immune thrombocytopenia (ITP) is characterized by low platelet counts and a tendency toward increased bleeding and bruising. We aimed to describe bleeding frequency and use of rescue ITP therapy to treat or prevent bleeding in elderly ITP patients in a real-world setting. METHODS: Using Medicare 20% sample data, 2007-2012, we identified elderly (ages ≥67 years) Medicare fee-for-service enrollees diagnosed with primary ITP between 1 January 2009 and 30 September 2012...
August 24, 2017: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/28726165/long-term-outcomes-of-laparoscopic-versus-open-splenectomy-for-immune-thrombocytopenia
#18
Kazuhiro Tada, Masayuki Ohta, Kunihiro Saga, Hiroomi Takayama, Teijiro Hirashita, Yuichi Endo, Hiroki Uchida, Yukio Iwashita, Masafumi Inomata
PURPOSE: Splenectomy is the standard therapy for medically refractory immune thrombocytopenia (ITP). Laparoscopic splenectomy (LS) has gained wide acceptance; however, the long-term outcomes of LS versus open splenectomy (OS) for patients with ITP remain unclear. METHODS: We analyzed, retrospectively, 32 patients who underwent splenectomy, as LS in 22 and OS in 10, for refractory ITP at our institute. Data were evaluated based on the American Society of Hematology 2011 evidence-based practice guidelines for ITP...
July 19, 2017: Surgery Today
https://www.readbyqxmd.com/read/28716661/the-prevalence-and-morphometry-of-an-accessory-spleen-a-meta-analysis-and-systematic-review-of-22-487-patients
#19
REVIEW
Jens Vikse, Beatrice Sanna, Brandon Michael Henry, Dominik Taterra, Silvia Sanna, Przemysław A Pękala, Jerzy A Walocha, Krzysztof A Tomaszewski
BACKGROUND: An accessory spleen (AS) is a lobule of splenic tissue found in ectopic locations. Identification of AS is particularly important in patients with immune thrombocytopenia (ITP) requiring splenectomy as unrecognized AS can later cause refractory symptoms. The AS can also be a source of significant intraabdominal hemorrhage. The aim of this meta-analysis was to systematically analyze the data on the prevalence, number, location, and morphometry of AS. MATERIALS AND METHODS: An extensive search of the major electronic databases was conducted to identify all studies that reported relevant data on the AS...
July 15, 2017: International Journal of Surgery
https://www.readbyqxmd.com/read/28698844/dapsone-therapy-for-refractory-immune-thrombocytopenia-patients-a-case-series
#20
Ji Yun Lee, Jeong-Ok Lee, Joo Young Jung, Soo-Mee Bang
BACKGROUND: Dapsone has been recommended as a second-line immunosuppressive agent for patients with immune thrombocytopenia (ITP). METHODS: We retrospectively analyzed the efficacy and safety of dapsone therapy in patients with ITP. RESULTS: Nine ITP patients were treated with dapsone at a dose of 50-100 mg/day between May 2013 and March 2016. All patients were refractory to multiple previous treatments, with a median of 7 agents (range, 4-8), and 3 patients had undergone a previous splenectomy...
June 2017: Blood Research
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