Kojouri K, Vesely SK, Terrel DR et al.: Splenectomy for adult patients with idiopathic thrombocytopenic purpura: a systematic review to assess longterm platelet count responses, prediction of response, and surgical complications. Blood 104: 2623-34

Hematology-Oncology Section, Department of Medicine, College of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, USA.
Blood (Impact Factor: 10.43). 12/2004; 104(9):2623-34. DOI: 10.1182/blood-2004-03-1168
Source: PubMed

ABSTRACT Splenectomy has been a standard treatment for adult patients with idiopathic thrombocytopenic purpura (ITP) for more than 50 years. However, the durability of responses, the ability to predict who will respond, and the frequency of surgical complications with splenectomy all remain uncertain. To better interpret current knowledge we systematically identified and reviewed all 135 case series, 1966 to 2004, that described 15 or more consecutive patients who had splenectomy for ITP and that had data for 1 of these 3 outcomes. Complete response was defined as a normal platelet count following splenectomy and for the duration of follow-up with no additional treatment. Forty-seven case series reported complete response in 1731 (66%) of 2623 adult patients with follow-up for 1 to 153 months; complete response rates did not correlate with duration of follow-up (r = -0.103, P = .49). None of 12 preoperative characteristics that have been reported consistently predicted response to splenectomy. Mortality was 1.0% (48 of 4955 patients) with laparotomy and 0.2% (3 of 1301 patients) with laparoscopy. Complication rates were 12.9% (318 of 2465) with laparotomy and 9.6% (88 of 921 patients) with laparoscopic splenectomy. Although the risk of surgery is an important consideration, splenectomy provides a high frequency of durable responses for adult patients with ITP.

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    • "In addition, many patients with chronic ITP are reluctant to have splenectomy because of fear of complications such as bleeding, infection, thrombosis , and the reported mortality rates of 0.2– 1.0% [Kojouri et al. 2004]. "
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    ABSTRACT: Chronic immune thrombocytopenia (ITP) is an autoimmune disorder characterized by a low platelet count that has persisted for more than 12 months. Patients may be asymptomatic but those with severe disease may have significant morbidity and require treatment. Corticosteroids and intravenous immunoglobulin are recommended as first-line treatments. Recently, two thrombopoietin-receptor agonists, romiplostim and eltrombopag have been licensed for the treatment of chronic ITP. The current indications for thrombopoietin-receptor agonists are for splenectomized adult patients with chronic ITP who are refractory to other treatments and adult nonsplenectomized patients in whom splenectomy is contraindicated. This article reviews data on the pharmacology, clinical efficacy and safety profile of eltrombopag in the treatment of ITP.
    06/2012; 3(3):155-64. DOI:10.1177/2040620712442525
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    • "Most of the patients unresponsive to corticosteroids and/or IVIG require a second-line therapy, either splenectomy or medical therapy (Kojouri et al, 2004; Zaja et al, 2010). Two thrombopoietin receptor agonists (TRAs), romiplostim and eltrombopag, have been recently licensed for use in patients with chronic and refractory ITP (Kuter et al, 2008; Bussel et al, 2009). "
    British Journal of Haematology 11/2011; 157(2):256-8. DOI:10.1111/j.1365-2141.2011.08950.x · 4.96 Impact Factor
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    • "The side effects of treatment are an important consideration and often guide the clinician's choices. Splenectomy is associated with a number of intra-and peri-operative complications, although the laparoscopic procedure is associated with lower complication and mortality rates than open splenectomy (Kojouri et al, 2004). The risk of overwhelming post-splenectomy is probably small, but quantifying the risk is difficult because of the lack of consistent data. "
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    ABSTRACT: A clinical syndrome of bleeding and purpura consistent with a diagnosis of immune thrombocytopenia (ITP) was described by Werlhof long before platelets were identified as the cellular component of blood playing an essential role in primary haemostasis. Although a role for the spleen was suggested nearly a century ago, the pathophysiology of ITP has remained elusive for many decades. During this time Werlhof's disease was renamed idiopathic thrombocytopenic purpura, from which the acronym ITP originally derives. The second half of the 20th century brought recognition of the autoimmune components of ITP, and hence the need for a new standard nomenclature, which has recently been accepted. ITP currently stands for Immune Thrombocytopenia, a name that more appropriately reflects the low platelet count rather than purpura as the main feature of the disease, as well as to defining its underlying nature. Advances in our knowledge of the disease have paralleled the availability of new therapeutic agents, and we are now entering an era of pathophysiologically-based treatment options.
    British Journal of Haematology 04/2011; 153(4):437-50. DOI:10.1111/j.1365-2141.2010.08562.x · 4.96 Impact Factor
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