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Oh Y, Yoo SY, Choi GS, Kim G. Liver transplantation of a patient with extreme thrombocytopenia - A case report. Anesth Pain Med (Seoul) 2021; 16:279-283. [PMID: 34233411 PMCID: PMC8342821 DOI: 10.17085/apm.21006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 05/17/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Patients with chronic liver disease (CLD) planned for liver transplantation (LT) often show severe thrombocytopenia, but there is a lack of evidence in deciding the threshold for prophylactic platelet transfusion. CASE A 47-year-old female with acute liver failure was referred for LT. Despite daily transfusion of platelets, platelet counts remained under 10,000/µl. During LT, 2 units of single donor platelets (SDP) were transfused. Although platelet counts remained extremely low (3,000-4,000/µl) no diffuse oozing was observed and the blood loss was 860 ml. Postoperatively, there was no sign of active bleeding or oozing, and the patient received only 1 unit SDP transfusion. CONCLUSIONS CLD patients may have severe thrombocytopenia. However, primary hemostasis may not be significantly hindered due to the existence of rebalanced hemostasis. Prophylactic platelet transfusion in these patients should not be decided based on platelet counts only, but also take other coagulation tests and clinical signs into consideration.
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Affiliation(s)
- Yena Oh
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Yeon Yoo
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gyu-Seong Choi
- Department of Transplantation Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gaabsoo Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Radkowiak D, Wysocki M, Zychowicz A, Lasek A, Major P, Pędziwiatr M, Budzyński P, Zub-Pokrowiecka A, Budzyński A. Is ITP really a desirable indication for teaching laparoscopic splenectomy? Cohort study. Acta Chir Belg 2019; 119:376-383. [PMID: 30624145 DOI: 10.1080/00015458.2018.1545743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: We aimed to evaluate the outcomes of laparoscopic splenectomy (LS) in patients with immune thrombocytopenic purpura (ITP) compared with operated for other indications. Methods: Retrospective cohort study of patients who underwent LS in 1998-2017. Group 1 consisted of 256 patients operated for ITP, and Group 2 of 231 operated for other indications. Primary outcome was procedure difficulty. Secondary was perioperative course (30 days of surgery). Results: Patients in Group 1 were younger (p < .001) with lower ASA (p < .001). The spleen was larger in Group 2 (p < .001). Operative time was longer in Group 2 [110 (80-150) vs. 90 (65-115) min; p < .001)]. Intraoperative blood loss was greater in Group 2 (p < .001). Conversions were higher in Group 2 (4.76 vs. 6.93%, p = .037), as were intraoperative complications (7.79 vs. 3.91%, p = .048). Morbidity, reoperations and mortality did not differ between groups (respectively, p = .899, .697, and .999). Median length of stay was similar (p = .211). Among the first 10 LSs performed by trainees, 63.66% were done for ITP. Later (after 11+ procedures) this dropped to 48.12% (p = .002). Conclusions: ITP may be a preferred indication for surgeons training for LS. Patients' characteristics and intraoperative factors allow an expectation for a relatively easy and hassle-free operation in those patients.
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Affiliation(s)
- Dorota Radkowiak
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland
| | - Michał Wysocki
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland
- Training and Innovation in Surgery (CERTAIN Surgery), Centre for Research, Krakow, Poland
| | - Anna Zychowicz
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland
| | - Anna Lasek
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland
| | - Piotr Major
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland
- Training and Innovation in Surgery (CERTAIN Surgery), Centre for Research, Krakow, Poland
| | - Michał Pędziwiatr
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland
- Training and Innovation in Surgery (CERTAIN Surgery), Centre for Research, Krakow, Poland
| | - Piotr Budzyński
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland
| | - Anna Zub-Pokrowiecka
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland
| | - Andrzej Budzyński
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland
- Training and Innovation in Surgery (CERTAIN Surgery), Centre for Research, Krakow, Poland
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Deshayes S, Godeau B. Second-line and beyond: treatment options for primary persistent and chronic immune thrombocytopenia. Platelets 2019; 31:291-299. [DOI: 10.1080/09537104.2019.1636018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Samuel Deshayes
- Service de Médecine Interne, Normandie Univ, UNICAEN, CHU de Caen Normandie, Caen, France
- Service de Médecine Interne, Centre de Référence des Cytopénies Auto-Immunes de l’Adulte, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris Est Créteil, Créteil, France
| | - Bertrand Godeau
- Service de Médecine Interne, Centre de Référence des Cytopénies Auto-Immunes de l’Adulte, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris Est Créteil, Créteil, France
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Laparoscopic splenectomy: posterolateral approach in patients with liver cirrhosis and portal hypertension with platelet count lower than 1 × 10 9/l. Wideochir Inne Tech Maloinwazyjne 2018; 13:454-459. [PMID: 30524615 PMCID: PMC6280078 DOI: 10.5114/wiitm.2018.77262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 06/06/2018] [Indexed: 01/11/2023] Open
Abstract
Introduction Laparoscopic splenectomy for massive splenomegaly secondary to liver cirrhosis and portal hypertension in patients with an extremely low platelet count (< 1 × 109/l) presents several challenges. The posterolateral laparoscopic splenectomy approach may be a feasible and safe technique for these patients. Aim To evaluate the feasibility and safety of the posterolateral laparoscopic splenectomy approach in patients with platelet counts < 1 × 109/l secondary to liver cirrhosis and portal hypertension. Material and methods In the period from January 2013 to December 2016, 11 patients with platelet counts < 1 × 109/l secondary to liver cirrhosis and portal hypertension underwent posterolateral laparoscopic splenectomy in our institution. Pre-, peri-, and postoperative medical managements were reviewed retrospectively. Results Patients’ median platelet count was 0.7 × 109/l at the time of inpatient admission. The median operating time was 75 min, and the median intraoperative blood loss was 30 ml. One patient underwent intraoperative transfusion. The median duration of postoperative hospital stay was 5 days. No intra- or postoperative complications ensued, all patients were followed for 12–32 months (median: 24 months), and none had postoperative complications. Conclusions The posterolateral laparoscopic splenectomy approach is a feasible, safe technique in the treatment of patients with platelet counts < 1 × 109/l secondary to liver cirrhosis and portal hypertension.
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Laparoscopic splenectomy for immune thrombocytopenia in patients with a very low platelet count. Wideochir Inne Tech Maloinwazyjne 2018; 13:157-163. [PMID: 30002747 PMCID: PMC6041578 DOI: 10.5114/wiitm.2018.75847] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 02/19/2018] [Indexed: 01/02/2023] Open
Abstract
Introduction Laparoscopic splenectomy (LS) is the gold standard in treating immune thrombocytopenia (ITP). However, there are still some problems in decision-making when considering LS in patients with a very low platelet count (PLT). Aim To evaluate safety outcomes of LS in patients with severe ITP and very low PLT in comparison to those with higher PLT. Material and methods We retrospectively analyzed consecutive patients who underwent LS in a single institution between April 1998 and December 2017. Perioperative care was based on an algorithm developed at our department which takes into consideration the patient's PLT level. Patients were divided into 2 groups depending on the PLT level (cut-off point 50,000/mm3). Results The mean operative time in the low PLT group and high PLT group was 90 ±42.1 min and 95 ±45 min, respectively (p = 0.59). Intraoperative blood loss was 144 ±226.1 ml in the low PLT group and 83 ±161.24 ml in the high PLT group (p = 0.23). Complications occurred in 5 (9.09%) patients in the low PLT group and 16 (11.51%) in the high PLT group (p = 0.67). There were no conversions in the group with lower PLT, while 2 patients in the group with higher PLT had to be converted to open surgery (p = 0.38). Patients with low PLT preoperatively more often required perioperative platelet transfusions (13 vs. 1, p < 0.001). Conclusions Laparoscopic splenectomy is safe and feasible treatment in patients with ITP regardless of the PLT level. Still, patients with critical ITP and marginally low PLT require special awareness.
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Moris D, Dimitriou N, Griniatsos J. Laparoscopic Splenectomy for Benign Hematological Disorders in Adults: A Systematic Review. ACTA ACUST UNITED AC 2018; 31:291-302. [PMID: 28438854 DOI: 10.21873/invivo.11058] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 03/10/2017] [Accepted: 03/13/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Since its introduction in the early 1990s, laparoscopic splenectomy (LS) has gained worldwide acceptance for spleen removal, especially in hematological patients. AIM The present review summarizes the current knowledge and results of LS for the treatment of benign hematological diseases in adults. MATERIALS AND METHODS A MEDLINE/PubMed database research was performed using the terms: "laparoscopic splenectomy" OR "laparoscopy" OR "splenectomy" AND "hematological disorders" OR "hematological disease" OR "hematology" AND "adults" as key words. We set our analysis starting date as January 1st 2010 and the end date as December 31st 2016. We identified 247 relative articles. All the references from the identified articles were searched for relevant information. RESULTS Twenty-seven articles were deemed appropriate for our analysis. LS was found to be feasible and safe in the majority of patients with benign hematological disorders, with a mortality rate ranging from 0% to less than 4% and the postoperative complications rate from 0% to 35.7%. The conversion rate was also very low (4%) and response (complete or partial) was achieved in more than 80% of patients. Lateral approach with four trocars was the most commonly used approach with concommitant cholecystectomy being correlated with increased operative time and morbidity. CONCLUSION Current literature holds that whenever splenectomy is required for the treatment of hematological disorders in adults, a laparoscopic approach should be offered as the gold standard. However, to strengthen the clinical evidence in favor of LS, more high-quality clinical trials on several issues of the procedure are necessary.
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Affiliation(s)
- Demetrios Moris
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, U.S.A.
| | - Nikoletta Dimitriou
- First Department of Surgery, National and Kapodistrian University of Athens, Medical School, Laikon General Hospital, Athens, Greece
| | - John Griniatsos
- First Department of Surgery, National and Kapodistrian University of Athens, Medical School, Laikon General Hospital, Athens, Greece
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Splenectomy for immune thrombocytopenia: down but not out. Blood 2018; 131:1172-1182. [PMID: 29295846 DOI: 10.1182/blood-2017-09-742353] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 11/29/2017] [Indexed: 01/19/2023] Open
Abstract
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, 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% to 70%) compared with other ITP therapies. However, there are no reliable predictors of splenectomy response, and long-term risks of infection and cardiovascular complications must be considered. Because the long-term efficacy of different second-line medical therapies for ITP have not been directly compared, treatment decisions must be made without supportive evidence. Splenectomy continues to be a reasonable treatment option for many patients, including those with an active lifestyle who desire freedom from medication and monitoring, and patients with fulminant ITP that does not respond well to medical therapy. We try to avoid splenectomy within the first 12 months after ITP diagnosis for most patients to allow for spontaneous or therapy-induced remissions, particularly in older patients who have increased surgical morbidity and lower rates of response, and in young children. Treatment decisions must be individualized based on patients' comorbidities, lifestyles, and preferences. Future research should focus on comparing long-term outcomes of patients treated with different second-line therapies and on developing personalized medicine approaches to identify subsets of patients most likely to respond to splenectomy or other therapeutic approaches.
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Gupta S, Kalayarasan R, Chandrasekar S, Gnanasekaran S, Pottakkat B. Laparoscopic Splenectomy for Immune Thrombocytopenic Purpura (ITP) Patients with Very Severe Thrombocytopenia. Indian J Hematol Blood Transfus 2017; 34:535-539. [PMID: 30127567 DOI: 10.1007/s12288-017-0902-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 11/18/2017] [Indexed: 12/22/2022] Open
Abstract
Laparoscopic approach is considered as gold standard for splenectomy in patients with Immune Thrombocytopenic purpura (ITP). The evidence for safety and feasibility of laparoscopic splenectomy (LS) in patients with very severe thrombocytopenia (< 10,000 μL) is limited. A retrospective study of 32 ITP patients who underwent LS between July 2012 and November 2016. The ITP patients who had platelet counts < 10,000 μL (Group A, n = 15) and > 10,000 μL (Group B, n = 17) were compared with respect to operative time, blood loss, conversion rate, perioperative blood transfusion, the length of hospital stay and postoperative complications. There was no significant difference between the two groups with respect to operative time (p = 0.07), intraoperative blood loss (p = 0.75), postoperative complications (p = 0.23) and hospital stay (p = 0.15). None of the patients in the two groups required conversion to open procedure. No intra operative blood transfusion was required. In Group A, 3 patients (with platelet count less than 2000 μL) received platelet transfusion at induction of anesthesia while 10 others received after ligation of the splenic artery. There was no difference in the operative time, blood loss, postoperative complications and hospital stay between them. LS is a safe and feasible procedure for ITP patients with very severe thrombocytopenia. In these patients, the timing of intraoperative platelet transfusion does not influence perioperative and anesthetic complications.
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Affiliation(s)
- Shahana Gupta
- Department of Surgical Gastroenterology, JIPMER, Room no 551, Fourth floor, Superspeciality block, Puducherry, 605006 India
| | - Raja Kalayarasan
- Department of Surgical Gastroenterology, JIPMER, Room no 551, Fourth floor, Superspeciality block, Puducherry, 605006 India
| | - Sandip Chandrasekar
- Department of Surgical Gastroenterology, JIPMER, Room no 551, Fourth floor, Superspeciality block, Puducherry, 605006 India
| | - Senthil Gnanasekaran
- Department of Surgical Gastroenterology, JIPMER, Room no 551, Fourth floor, Superspeciality block, Puducherry, 605006 India
| | - Biju Pottakkat
- Department of Surgical Gastroenterology, JIPMER, Room no 551, Fourth floor, Superspeciality block, Puducherry, 605006 India
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Abstract
Immune thrombocytopenia (ITP) is an autoimmune condition that can cause life-threatening bleeding. ITP may develop idiopathically, after an infection or administration of a medication, or as a comorbid condition. Treatment depends on whether life-threatening, active bleeding is occurring. Although corticosteroids remain a standard of care, new medications offer patients an alternative to splenectomy when other pharmacologic treatments fail.
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Martin Arnau B, Turrado Rodriguez V, Tartaglia E, Bollo Rodriguez J, Targarona EM, Trias Folch M. Impact of preoperative platelet count on perioperative outcome after laparoscopic splenectomy for idiopathic thrombocytopenic purpura. Cir Esp 2016; 94:399-403. [PMID: 27426032 DOI: 10.1016/j.ciresp.2016.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 05/04/2016] [Accepted: 05/05/2016] [Indexed: 10/21/2022]
Abstract
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). RESULTS Operative time was significantly lower in Group III compared to Group I and II (100±53 and 105±61min, P<.025)). Intraoperative blood loss was statistically higher in group i (263±551ml) with respect to the other 2: group ii (128±352ml) and group iii (24±62ml) (P<.003). Hospital stay was 6.4±5.8 days in group i, significantly higher compared to groups ii and iii (3.8±2.3 and 3.2±1.8 days, respectively (P<.003)). CONCLUSION Conducting a LS in ITP patients with low platelet counts is effective and safe.
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Affiliation(s)
- Belén Martin Arnau
- Servicio de Cirugía General y Aparato Digestivo, Hospital Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, España.
| | - Víctor Turrado Rodriguez
- Servicio de Cirugía General y Aparato Digestivo, Hospital Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, España
| | - Ernesto Tartaglia
- Servicio de Cirugía General y Aparato Digestivo, Hospital Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, España
| | - Jesús Bollo Rodriguez
- Servicio de Cirugía General y Aparato Digestivo, Hospital Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, España
| | - Eduardo M Targarona
- Servicio de Cirugía General y Aparato Digestivo, Hospital Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, España
| | - Manuel Trias Folch
- Servicio de Cirugía General y Aparato Digestivo, Hospital Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, España
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Li Y, Zhang D, Hua F, Gao S, Wu Y, Xu J. Factors associated with the effect of open splenectomy for immune thrombocytopenic purpura. Eur J Haematol 2016; 98:44-51. [PMID: 27245379 DOI: 10.1111/ejh.12783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2016] [Indexed: 11/30/2022]
Abstract
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. Preoperative factors were identified by logistic regression analysis. RESULTS Fifty-six patients (48.2 ± 16.2 yr old; 39 females) were included. Disease course was 31.2 ± 48.2 months; 91.1% patients had preoperative platelet count <20 × 109 /L. OS effect at 1 wk, 1 month, 1 yr, and 5 yrs was in 91.1%, 92.9%, 91.1%, and 89.3% patients, respectively. Pneumonia or lower extremity thrombosis occurred in 7.1% patients. Postoperative mild, moderate, and severe bleeding occurred in 33.9%, 50.0%, and 16.1% patients, respectively. No patients required blood transfusion. Mortality was zero. Larger spleen size associated with surgical effect at 1 wk, 1 month, and 1 yr, and lower preoperative minimum platelet count associated with effect at 5 yrs (P < 0.05). CONCLUSIONS Open splenectomy is an effective treatment with less complications for the management of ITP. Lower preoperative minimum platelet count associated with successful OS at 5 yrs.
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Affiliation(s)
- Ying Li
- Department of Hematology, Jinshan Hospital Fudan University, Shanghai, China
| | - Dawei Zhang
- Department of Hematology, Jinshan Hospital Fudan University, Shanghai, China
| | - Fanli Hua
- Department of Hematology, Jinshan Hospital Fudan University, Shanghai, China
| | - Song Gao
- Department of Hematology, Jinshan Hospital Fudan University, Shanghai, China
| | - Yangjiong Wu
- Department of Hematology, Jinshan Hospital Fudan University, Shanghai, China
| | - Jianmin Xu
- Department of Hematology, Zhongshan Hospital Fudan University, Shanghai, China
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Vecchio R, Intagliata E, La Corte F, Marchese S, Cacciola RR, Cacciola E. Late results after splenectomy in adult idiopathic thrombocytopenic purpura. JSLS 2016; 19:e2013.00272. [PMID: 25848175 PMCID: PMC4370036 DOI: 10.4293/jsls.2013.00272] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: We performed a retrospective study on patients with idiopathic thrombocytopenic purpura (ITP) to evaluate the response to splenectomy in relation to preoperative platelet count. Materials and Methods: Two groups of patients operated on with laparoscopic or open splenectomy for ITP, with a platelet count ≤30,000/μL (study group: 22 patients) and >30,000/μL (control group: 18 patients), respectively, were compared. The two groups were homogeneous in relation to age, sex, length of preoperative steroid therapy, and time interval between diagnosis and surgery (Student t test with P > .1). The results of surgery were evaluated at one year after splenectomy. Positive response to surgery, according to the American Society of Hematologic Guidelines, was considered in patients with a postoperative platelet count ≥100,000/μL or in patients with a postoperative platelet count ≥30,000/μL and a twofold increase in platelet count from baseline, in the absence of bleeding. The postoperative platelet count increase rate was statistically related to preoperative platelet count in both the study and control groups. Statistical analysis was performed using the Student's t test for independent sample and the Pearson correlation in a 2-tailed test. Results: No relationship between preoperative platelet count and postoperative platelet percent increase was observed in the control group (r = –0.41; P = .089), whereas a significant negative correlation (r = –0.68; P = .0004) was found in the study group. Conclusions: A higher increase of postoperative percent platelet count may be predicted in patients with a low preoperative platelet count.
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Affiliation(s)
- Rosario Vecchio
- Department of Surgery, University of Catania, Italy, Catania, Italy
| | - Eva Intagliata
- Department of Surgery, University of Catania, Italy, Catania, Italy
| | | | | | - Rossella R Cacciola
- Hematologic Unit, Department of Biomedical Science, University of Catania, Catania Italy
| | - Emma Cacciola
- Hematologic Unit, Department of Biomedical Science, University of Catania, Catania Italy
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Prevention and treatment of hemorrhage during laparoscopic splenectomy and devascularization for portal hypertension. ACTA ACUST UNITED AC 2015; 35:99-104. [DOI: 10.1007/s11596-015-1396-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 11/18/2014] [Indexed: 12/11/2022]
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[Successful management of severe bleeding in a child of immune thrombocytopenia by preoperation splenic artery embolization plus laparoscopic splenectomy: a case report and literature review]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2015; 36:66-7. [PMID: 25641152 PMCID: PMC7343027 DOI: 10.3760/cma.j.issn.0253-2727.2015.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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15
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Bansal D, Rajendran A, Singhi S. Newly diagnosed immune thrombocytopenia: update on diagnosis and management. Indian J Pediatr 2014; 81:1033-41. [PMID: 24091868 DOI: 10.1007/s12098-013-1217-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 08/07/2013] [Indexed: 02/07/2023]
Abstract
Immune thrombocytopenia (ITP) continues to intrigue pediatricians and hematologists alike. Patients can have a dramatic presentation with wide-spread bleeds over a few days. There is an aura and fear of intra-cranial hemorrhage that drives the physician to recommend and the patient's family to accept drug treatment. Difference of opinion among physicians in the recommendations for treatment is not uncommon, even though recent evidence-based guidelines recommend a conservative, observation-based approach for the majority of patients with newly diagnosed childhood ITP. It is important to note that a specific 'platelet cut-off count', is no longer suggested as an indication by itself to recommend drug therapy. The manuscript is an update on newly diagnosed ITP in children. Recent changes in definitions and recommendations for treatment are highlighted. Pros and cons of 1st line drugs, including corticosteroids, intravenous immunoglobulin and anti-D are listed. Adjunctive therapies for the management of epistaxis and menorrhagia are described. Role of splenic artery embolization and emergency splenectomy in the backdrop of severe thrombocytopenia is discussed. Realistic case scenarios, common errors and frequently asked questions are included for a practical and easy reading.
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Affiliation(s)
- Deepak Bansal
- Hematology-Oncology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Jolliffe E, Romeril K. Eltrombopag for resistant immune thrombocytopenia secondary to chronic lymphocytic leukaemia. Intern Med J 2014; 44:697-9. [DOI: 10.1111/imj.12468] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 04/03/2014] [Indexed: 11/28/2022]
Affiliation(s)
- E. Jolliffe
- Wellington Blood and Cancer Centre; Capital and Coast District Health Board; Wellington New Zealand
| | - K. Romeril
- Wellington Blood and Cancer Centre; Capital and Coast District Health Board; Wellington New Zealand
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Laparoscopic splenectomy: perioperative management, surgical technique, and results. J Gastrointest Surg 2014; 18:404-10. [PMID: 24114681 DOI: 10.1007/s11605-013-2366-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 09/20/2013] [Indexed: 01/31/2023]
Abstract
Since their introduction in the early 1990s, minimally invasive techniques have gained widespread acceptance because of the significant benefits that patients are able to experience. Some of these benefits include reduced postoperative pain, earlier return to normal activity, and improved cosmesis when compared with open surgery. For these reasons, since its first description by Delaitre and Maignien in 1991, laparoscopic splenectomy (LS) has been increasingly utilized for a safe surgical removal of the spleen with nearly equivalent or superior short- and long-term outcomes when compared with the open approach. In this technical report, we aim to describe our preoperative and postoperative management of patients undergoing LS and to illustrate our preferred surgical technique, its rationale, and our results.
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Wang M, Zhang M, Zhou J, Wu Z, Zeng K, Peng B, Niu T. Predictive factors associated with long-term effects of laparoscopic splenectomy for chronic immune thrombocytopenia. Int J Hematol 2013; 97:610-6. [DOI: 10.1007/s12185-013-1328-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 04/08/2013] [Accepted: 04/09/2013] [Indexed: 11/29/2022]
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Wu Z, Zhou J, Prsoon P, Wei X, Liu X, Peng B. Low expression of FCGRIIB in macrophages of immune thrombocytopenia-affected individuals. Int J Hematol 2012; 96:588-93. [PMID: 23054650 DOI: 10.1007/s12185-012-1187-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 09/19/2012] [Accepted: 09/20/2012] [Indexed: 02/05/2023]
Abstract
Immune thrombocytopenia (ITP) is an autoimmune disorder described as autoantibody-mediated platelet deterioration. Platelets with affiliated IgG are targeted for exploitation by Fc receptor-mediated phagocytic cellular material within the reticuloendothelial system. The objective of this research is to investigate the relationship between the appearance of FC gamma receptors (FCGR) IIB and IIIA on macrophages and clinicopathological characteristics in ITP patients. FCGRIIB and FCGRIIIA were recognized by immunohistochemistry staining of 62 samples, including regular (n = 20) and ITP (n = 42) samples. Subsequently, the relationship of FC gamma expression levels to ITP progression and clinicopathological characteristics was statistically reviewed. Furthermore, the relationship between Helicobacter pylori (HP) infection and FC gamma expression was analyzed. IHC staining with the coordinated spleen tissue trial samples showed that expression of FCGRIIB on macrophages of ITP patients was tremendously reduced in comparison to the healthy control group. However, no variance was discovered between the two groups with respect to FCGRIIIA expression. There was no substantial correlation among FCGRIIB and FCGRIIIA expression and patient age and gender. Significant differences were found between HP infection and decreased expression of FCGRIIB, while there was no difference with the expression of FCGRIIIA. Lower expression of FCGRIIB is likely involved in the etiology of ITP. HP infection is correlated with decreased expression of FCGRIIB. A rise in FCGRIIB may serve as a therapeutic target for human ITP treatment or possibly as a biomarker for ITP analysis.
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Affiliation(s)
- Zhong Wu
- Department of Hepatopancreatobiliary Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
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Eskazan AE, Salihoglu A, Gulturk E, Aydin SO, Tuzuner N, Aydin Y. Successful management of chronic refractory immune thrombocytopenia with laparoscopic splenectomy in a patient with acute promyelocytic leukemia. Indian J Hematol Blood Transfus 2012; 29:173-7. [PMID: 24426368 DOI: 10.1007/s12288-012-0173-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2012] [Accepted: 06/11/2012] [Indexed: 11/25/2022] Open
Abstract
Acute promyelocytic leukemia (APL) is a particular type of acute myeloid leukemia with characteristic biological and clinical features, the frequent association at diagnosis of a severe hemorrhagic diathesis. Immune thrombocytopenia (ITP) is a common autoimmune disease characterized by low platelet counts and an increased risk of bleeding. Here we present a patient with the diagnosis of APL who achieved and maintained a remission with an induction consisting of idarubicin and ATRA, and then developed corticosteroid refractory ITP which is successfully treated with laparoscopic splenectomy.
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Affiliation(s)
- Ahmet Emre Eskazan
- Department of Hematology, Diyarbakir Training and Research Hospital, Diyarbakir, Turkey
| | - Ayse Salihoglu
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Emine Gulturk
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Seniz Ongoren Aydin
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nukhet Tuzuner
- Department of Pathology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yildiz Aydin
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
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