Idiopathic thrombocytopenic purpura surgery: Difference between revisions
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==Overview== | ==Overview== | ||
==Surgery== | ==Surgery== | ||
[[Splenectomy]] is safe and effective in ~80% of patients with refractory HIV-related [[thrombocytopenia]] and treated with [[interferon]] (IFN) may be effective in refractory cases of patients coinfected with HCV. A decrease in platelets in HIV can arise secondary to both HCV and hepatitis B (HBV). | ===Splenectomy=== | ||
Splenectomy offers a 2nd line treatment for those who fail [[steroid]]s. The criteria for surgery are severe thrombocytopenia (<10,000), high risk of [[bleeding]] or the requirement of frequent [[steroid]]s/IVIgG/anti-D treatment to maintain an adequate [[platelet]] count. Of the ~15% of children with persistent thrombocytopenia bleeding symptoms are uncommon and [[splenectomy]] is rarely required. However splenectomy is an effective treatment option for children with severe / symptomatic thrombocytopenia with a CR of ~75%. Because of the risk for overwhelming [[sepsis]] after splenectomy it should be deferred until after 5 years of age. Remember to give [[immunization]]s before splenectomy and perioperative antibiotics. Response to IV-IgG often predicts a response to [[splenectomy]] (increasing the platelet count to >50,000 with IgG means a >90% RR to splenectomy).<ref name="pmid22740443">{{cite journal |vauthors=Ghanima W, Godeau B, Cines DB, Bussel JB |title=How I treat immune thrombocytopenia: the choice between splenectomy or a medical therapy as a second-line treatment |journal=Blood |volume=120 |issue=5 |pages=960–9 |date=August 2012 |pmid=22740443 |doi=10.1182/blood-2011-12-309153 |url=}}</ref> | |||
[[Splenectomy]] is safe and effective in ~80% of patients with refractory HIV-related [[thrombocytopenia]] and treated with [[interferon]] (IFN) may be effective in refractory cases of patients coinfected with HCV. A decrease in platelets in HIV can arise secondary to both HCV and hepatitis B (HBV).<ref name="pmid236645192">{{cite journal |vauthors=Schifferli A, Kühne T |title=Chronic immune thrombocytopenia in children: who needs splenectomy? |journal=Semin. Hematol. |volume=50 Suppl 1 |issue= |pages=S58–62 |date=January 2013 |pmid=23664519 |doi=10.1053/j.seminhematol.2013.03.010 |url=}}</ref> | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
[[Category:Hematology]] | [[Category:Hematology]] | ||
[[Category:Dermatology]] | [[Category:Dermatology]] | ||
Latest revision as of 19:36, 28 July 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Surgery
Splenectomy
Splenectomy offers a 2nd line treatment for those who fail steroids. The criteria for surgery are severe thrombocytopenia (<10,000), high risk of bleeding or the requirement of frequent steroids/IVIgG/anti-D treatment to maintain an adequate platelet count. Of the ~15% of children with persistent thrombocytopenia bleeding symptoms are uncommon and splenectomy is rarely required. However splenectomy is an effective treatment option for children with severe / symptomatic thrombocytopenia with a CR of ~75%. Because of the risk for overwhelming sepsis after splenectomy it should be deferred until after 5 years of age. Remember to give immunizations before splenectomy and perioperative antibiotics. Response to IV-IgG often predicts a response to splenectomy (increasing the platelet count to >50,000 with IgG means a >90% RR to splenectomy).[1]
Splenectomy is safe and effective in ~80% of patients with refractory HIV-related thrombocytopenia and treated with interferon (IFN) may be effective in refractory cases of patients coinfected with HCV. A decrease in platelets in HIV can arise secondary to both HCV and hepatitis B (HBV).[2]
References
- ↑ Ghanima W, Godeau B, Cines DB, Bussel JB (August 2012). "How I treat immune thrombocytopenia: the choice between splenectomy or a medical therapy as a second-line treatment". Blood. 120 (5): 960–9. doi:10.1182/blood-2011-12-309153. PMID 22740443.
- ↑ Schifferli A, Kühne T (January 2013). "Chronic immune thrombocytopenia in children: who needs splenectomy?". Semin. Hematol. 50 Suppl 1: S58–62. doi:10.1053/j.seminhematol.2013.03.010. PMID 23664519.