Jump to ContentJump to Main Navigation
Show Summary Details
More options …

Open Medicine

formerly Central European Journal of Medicine

Editor-in-Chief: Darzynkiewicz, Zbigniew

1 Issue per year


IMPACT FACTOR 2016 (Open Medicine): 0.294
IMPACT FACTOR 2016 (Central European Journal of Medicine): 0.116

CiteScore 2016: 0.28

SCImago Journal Rank (SJR) 2015: 0.140
Source Normalized Impact per Paper (SNIP) 2015: 0.154

Open Access
Online
ISSN
2391-5463
See all formats and pricing
More options …
Volume 6, Issue 1

Issues

Prognostic factors for positive immune thrombocytopenic purpura outcome after laparoscopic splenectomy

Mindaugas Kiudelis / Antanas Mickevicius / Ruta Dambrauskiene / Rolandas Gerbutavicius / Rasa Griniūtė / Dalia Adukauskiene
Published Online: 2010-12-16 | DOI: https://doi.org/10.2478/s11536-010-0063-0

Abstract

Laparoscopic splenectomy is considered as a second step treatment for ITP patients. The purpose of this study was to determine efficiency of laparoscopic splenectomy for ITP patients and to identify the independent prognostic factors that may predict the positive outcome. Two hundred and thirty nine patient medical records were analyzed retrospectively. The special questionnaire, which included present platelet count, the steroid usage and its dosage, was sent to all patients. The complete response (CR) was defined, when the platelet count was above 130 × 109 /L. The 239 adult patients with a median age of 51.3 (16–93 years) were included in this cohort. The median follow up period was 75 months. 49 patients, who relapsed after steroid treatment, underwent laparoscopic splenectomy. The short term postoperative CR was 71.4% after laparoscopic splenectomy compared to 38.1% in non-splenectomized patients (p < 0.000). The long term CR was 79.5 % in patients after splenectomy compared to 47.4% in non-splenectomized patients (p < 0.018). After univaried analysis three clinical variables were found to be significantly related to splenectomy outcome: disease duration (p<0.007), preoperative platelet count (p<0.049) and platelet count on the third postoperative day (p<0.000). Multiple logistic regression analysis demonstrated, that only platelet count on the 3rd postoperative day > 129 × 109 /L; RR=53.3 95% (CI, 1.888–1517.98) was significant predictor for long-term positive ITP outcome after laparoscopic splenectomy. Splenectomy is effective treatment for ITP. Platelet count > 129 × 109/L on the third postoperative day is the significant predictor of positive long-term outcome after laparoscopic splenectomy.

Keywords: Licorice; Laparoscopic splenectomy; ITP; platelet count

  • [1] Imbach P, Kühne T, Signer E Historical aspects and present knowledge of idiopathic thrombocytopenic purpura. (2002) Br J Haematol 119:894–900 http://dx.doi.org/10.1046/j.1365-2141.2002.03755.xCrossrefGoogle Scholar

  • [2] McMillan R Therapy for adults with refractory chronic immune thrombocytopenic purpura. (1997) Ann Int Med 126(4):307–314 CrossrefGoogle Scholar

  • [3] Stevens W, Koene H, Zwaginga JJ, Vreugdenhil G. Chronic idiopathic thrombocytopenic purpura: present strategy, guidelines and new insights. (2006) Neth J Med. Nov 64(10):356–363 Google Scholar

  • [4] Delaitre B, Maignien B. Splenectomy by the laparoscopic approach. (1991) Report of a case. Presse Med 20:2263 Google Scholar

  • [5] Delaitre B, Maignien B. Laparoscopic splenectomy — Technical aspects. (1992) Surg Endosc 6:305–308 http://dx.doi.org/10.1007/BF02498866CrossrefGoogle Scholar

  • [6] Consensus statement Laparoscopic splenectomy: the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES). (2008) Surg Endosc 22:821–848 Google Scholar

  • [7] Aksnes J, Abdelnoor M, Mathisen O Risk factors associated with mortality and morbidity after elective splenectomy. (1995) Eur J Surg 161: 253–258 Google Scholar

  • [8] Stasi R, Stipa E, Masi M, et al Long-term observation of 208 adults with chronic idiopathic thrombocytopenic purpura. (1995) American Journal of Medicine 98:436–4442 http://dx.doi.org/10.1016/S0002-9343(99)80342-8CrossrefGoogle Scholar

  • [9] McMillan R. Therapy for adults with refractory chronic immune thrombocytopenic purpura. (1997) Ann Intern Med 136:307–314 Google Scholar

  • [10] George JN, El-Harake MA, Raskob GE. Chronic idiopathic thrombocytopenic purpura. (1994) N Engl J Med 331:1207–1211 http://dx.doi.org/10.1056/NEJM199411033311807CrossrefGoogle Scholar

  • [11] Stasi R, Stipa E, Masi M, et al Long-term observation of 208 adults with chronic idiopathic thrombocytopenic purpura. (1995) American Journal of Medicine 98:436–442 http://dx.doi.org/10.1016/S0002-9343(99)80342-8CrossrefGoogle Scholar

  • [12] Bourgeois E, Caulier MT, Delarozee C, et al Long-term follow-up of chronic autoimmune thrombocytopenic purpura refractory to splenectomy: a prospective analysis. (2003) British Journal of Haematology 120:1079–1088 http://dx.doi.org/10.1046/j.1365-2141.2003.04211.xCrossrefGoogle Scholar

  • [13] Leung AYH, Chim CS, Kwong YL, et al Clinicopathologic and prognostic features of chronic idiopathic thrombocytopenic purpura in adult Chinese patients: an analysis of 220 cases. (2001) Annals of Hematology 80:384–386 http://dx.doi.org/10.1007/s002770100306CrossrefGoogle Scholar

  • [14] Rodeghiero F. Idiopathic thrombocytopenic purpura: an old disease revisited in the era of evidence-based medicine. (2003) Haematologica 88:1081–1087 Google Scholar

  • [15] Cheng Y, Wong RS, Soo YO, et al Initial treatment of immune thrombocytopenic purpura with high-dose dexamethasone. (2003) N Engl J Med 349:831–836 http://dx.doi.org/10.1056/NEJMoa030254CrossrefGoogle Scholar

  • [16] Alpdogan O, Budak-AldoGan T, Ratip S, et al Efficacy of high-dose methylprednisolone as a first-line therapy in adult patients with idiopathic thrombocytopenic purpura. (1998) Br J Haemat 103:1961–1963 http://dx.doi.org/10.1046/j.1365-2141.1998.01096.xCrossrefGoogle Scholar

  • [17] Stasi R, Provan D. Management of immune thrombocytopenic purpura in adults. (2004) Mayo Clin Proc 79:504–522 http://dx.doi.org/10.4065/79.4.504CrossrefGoogle Scholar

  • [18] Colovic M, Dimitrijevic M, Sonnenberg C, et al Clinical efficacy and safety of a novel intravenous immunoglobulin preparation in adult chronic ITP. (2003) Hematol J 4:358–362 http://dx.doi.org/10.1038/sj.thj.6200303CrossrefGoogle Scholar

  • [19] George JN, Woolf SH, Raskob GE, et al Idiopathic thrombocytopenic purpura: a guideline developed by explicit methods for the American Society of Hematology. (1996) Blood 88:3–40. Google Scholar

  • [20] Giagounidis AA, Anhuf J, Schneider P, et al Treatment of relapsed idiopathic thrombocytopenic purpura with the anti-CD20 monoclonal antibody rituximab: a pilot study. (2002) Eur J Haematol 69:95–100. http://dx.doi.org/10.1034/j.1600-0609.2002.02686.xCrossrefGoogle Scholar

  • [21] Zaja F, Vianelli N, Sperotto A, et al The B-cell compartment as the selective target for the treatment of immune thrombopenias. (2003) Haematology 88:538–546 Google Scholar

  • [22] Shanafelt TD, Madueme HL, Wolf RC, Tefferi A. Rituximab for immune cytopenia in adults: idiopathic thrombocytopenic purpura, autoimmune (2003) 78:1340–1346 Google Scholar

  • [23] Cooper N, Stasi R, Cunningham-Rundles S, et al The efficacy and safety of B-cell depletion with anti-CD20 monoclonal antibody in adults with chronic immune thrombocytopenic purpura. (2004) Br J Haematol 125:232–239 http://dx.doi.org/10.1111/j.1365-2141.2004.04889.xCrossrefGoogle Scholar

  • [24] Stasi R, Pagano A, Stipa E, Amadori S. Rituximab chimeric anti-CD20 monoclonal antibody treatment for adults with chronic idiopathic thrombocytopenic purpura. (2001) Blood 98:952–957 http://dx.doi.org/10.1182/blood.V98.4.952CrossrefGoogle Scholar

  • [25] Braendstrup P, Bjerrum OW, Nielsen OJ, et al Rituximab chimeric anti-CD20 monoclonal antibody treatment for adult refractory idiopathic thrombocytopenic purpura. (2005) Am J Hematol 78:275–280 http://dx.doi.org/10.1002/ajh.20276CrossrefGoogle Scholar

  • [26] Medeot M, Zaja F, Vianelli N, et al Rituximab therapy in adult patients with relapsed or refractory immune thrombocytopenic purpura: longterm follow-up results. (2008) Eur J Haematol 81(3):165–169 http://dx.doi.org/10.1111/j.1600-0609.2008.01100.xCrossrefGoogle Scholar

  • [27] Patel V, Mihatov N, Cooper N, et al Long term follow-up of patients with immune thrombocytopenic purpura whose initial response to rituximab lasted a minimum of 1 year. (2006) Blood (suppl):abstract 479 Google Scholar

  • [28] Kuter DJ, Bussel JB, Senecal FM, et al Evaluation of AMG 531 in nonsplenectomized patients with chronic immune thrombocytopenic purpura in a randomized placebo-controlled phase 3 study. (2007) Google Scholar

  • [29] Bussel JB, Kuter DJ, de Wolf JThM, et al Long-term dosing of AMG 531 in thrombocytopenic patients with immune thrombocytopenic purpura: 2-year update. (2007) Blood 110:174a, abstract number 568 Google Scholar

  • [30] Blanchette V, Freedman J, Garvey B. Management of chronic immune thrombocytopenic purpura in children and adults. (1998) Semin Hematol 35(suppl. 1):36–51 Google Scholar

  • [31] George JN, Kojouri K, Perdue JJ, Vesely SK Management of patients with chronic, refractory idiopathic thrombocytopenic purpura. (2000) Semin Hematol 37(3):290–298 http://dx.doi.org/10.1016/S0037-1963(00)90107-0CrossrefGoogle Scholar

  • [32] Maloisel F, Andres E, Zimmer J, et al Danazol therapy in patients with chronic idiopathic thrombocytopenic purpura: long-term results. (2004) Am J Med 116(9):590–594 http://dx.doi.org/10.1016/j.amjmed.2003.12.024CrossrefGoogle Scholar

  • [33] Andrès E, Zimmer J, Noel E, et al Idiopathic thrombocytopenic purpura: a retrospective analysis in 139 patients of the influence of age on the response to corticosteroids, splenectomy and danazol. (2003) Drugs Aging 20:841–846 http://dx.doi.org/10.2165/00002512-200320110-00005CrossrefGoogle Scholar

  • [34] Ahn YS, Rocha R, Mylvaganam R, et al Long-term danazol therapy in autoimmune thrombocytopenia: unmaintained remission and age-dependent response in women. (1989) Ann Int Med 111:723–729 CrossrefGoogle Scholar

  • [35] Kim SW, Rice L, McCarthy JJ. Efficacy of danazol with autoimmune thrombocytopenia. (1997) Clin Appl Thrombosis/Hemostasis 3:251–255 http://dx.doi.org/10.1177/107602969700300406CrossrefGoogle Scholar

  • [36] Rice L. Danazol, idiopathic thrombocytopenic purpura, and thrombopoietin. (2004) Am J Med 117(12):972–973 http://dx.doi.org/10.1016/j.amjmed.2004.10.003CrossrefGoogle Scholar

  • [37] Cohen YC, Djulbegovic B, Shamai-Lubovitz O, Mozes B. The bleeding risk and natural history of idiopathic thrombocytopenic purpura in patients with persistent low platelet counts. (2000) Arch Intern Med 160:1630–1638 http://dx.doi.org/10.1001/archinte.160.11.1630CrossrefGoogle Scholar

  • [38] Reiner A, Gernsheimer T, Slichter SJ. Pulse cyclophosphamide therapy forrefractory autoimmune thrombocytopenic purpura. (1995) Blood 85:351–358 Google Scholar

  • [39] Kappers-Klunne MC, van het Veer B. Cyclosporin A for the treatment of patients with chronic idiopathic thrombocytopenic purpura refractory to corticosteroids or splenectomy. (2001) Br J Haematol 114:212–215 http://dx.doi.org/10.1046/j.1365-2141.2001.02893.xCrossrefGoogle Scholar

  • [40] Perrota S, Amendola G, Locatelli F, et al Treatment with short-term, high-dose cyclosporine A in children with refractory chronic idiopathic thrombocytopenic purpura. (2003) Br J Haematol 121:143–147 http://dx.doi.org/10.1046/j.1365-2141.2003.04254.xCrossrefGoogle Scholar

  • [41] British Committee for Standards in Haemotology Guidelines for the investigation and management of idiopathic thrombocytopenic purpura in adults, children and in pregnancy. (2003) Br J Haematol 120:574–596 Google Scholar

  • [42] George JN, Woolf SH, Raskob GE, et al Idiopathic thrombocytopenic purpura: A practice guideline developed by explicit methods for the American Society of hematology. (1996) Blood 88:3–40 Google Scholar

  • [43] Kiarash Kjouri, Sara K. Vesely, Deirdra R. Terrell et al Splenectomy for adults with idiopathic thrombocytopenic purpura: a systematic review to assess long-term platelet count responses, prediction of response, and surgical complications. (2004) Blood 104:2623–2632 http://dx.doi.org/10.1182/blood-2004-03-1168CrossrefGoogle Scholar

  • [44] Stanton CJ. Laparoscopic splenectomy for idiopathic thrombocytopenic purpura (ITP): a five-year experience. (1999) Surg Endosc 13: 1083–1086 http://dx.doi.org/10.1007/s004649901178CrossrefGoogle Scholar

  • [45] Fabris F, Tassan T, Ramon R. et al Age as the major predictive factor of long-term response to splenectomy in immune thrombocytopenic purpura. (2001) Br J Haematol 112: 637–640 http://dx.doi.org/10.1046/j.1365-2141.2001.02615.xCrossrefGoogle Scholar

  • [46] Kumar S, Diehn FE, Gertz MA, Tefferi A. Splenectomy for immune thrombocytopenic purpura: long-term results and treatment of postsplenectomy relapses. (2002) Ann Hematol 81(6):312–319 http://dx.doi.org/10.1007/s00277-002-0461-8CrossrefGoogle Scholar

  • [47] Duperier T, Brody F, Felsher J, Walsh M, Rosen M, Ponsky J. Predictive factors for successful laparoscopic splenectomy in patients with immune thrombocytopenic purpura. (2004) Arch Surg 139: 61–66 http://dx.doi.org/10.1001/archsurg.139.1.61CrossrefGoogle Scholar

  • [48] Katkhouda N, Grant SW, Mavor E, et al Predictors of response after laparoscopic splenectomy for immune thrombocytopenic purpura. (2001) Surg Endosc 15:484–488 http://dx.doi.org/10.1007/s004640000355CrossrefGoogle Scholar

  • [49] Schiavotto C, Rodeghiero F. Twenty years experience with treatment of idiopathic thrombocytopenic purpura in a single department: results in 490 cases. (1993) Haematologica 78: 22–28 Google Scholar

  • [50] Radaelli F, Faccini P, Goldaniga M, et al Factors predicting response to splenectomy in adult patients with idiopathic thrombocytopenic purpura. (2000) Haematologica 85:1040–1044 Google Scholar

  • [51] Ruivard M, Caulier MT, Vantelon JM. The response to high-dose intravenous immunoglobulin or steroids is not predictive of outcome after splenectomy in adults with autoimmune thrombocytopenic purpura. (1999) Br J Haematol 105:1130–1132 http://dx.doi.org/10.1046/j.1365-2141.1999.01464.xCrossrefGoogle Scholar

  • [52] Wilde RC, Ellis LD, Cooper WM. Splenectomy for chronic idiopathic thrombocytopenic purpura. (1967) Arch Surg 95:344–350 CrossrefGoogle Scholar

  • [53] den Ottolander GJ, Gratama JW, deKoning J et al Long-term follow-up study of 168 patients with immune thrombocytopenia. (1984) Scand J Haematol 32:101–110 http://dx.doi.org/10.1111/j.1600-0609.1984.tb00684.xCrossrefGoogle Scholar

About the article

Published Online: 2010-12-16

Published in Print: 2011-02-01


Citation Information: Open Medicine, Volume 6, Issue 1, Pages 123–130, ISSN (Online) 2391-5463, DOI: https://doi.org/10.2478/s11536-010-0063-0.

Export Citation

© 2010 Versita Warsaw. This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License. BY-NC-ND 3.0

Comments (0)

Please log in or register to comment.
Log in