Idiopathic thrombocytopenic purpura surgery: Difference between revisions
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==Surgery== | ==Surgery== | ||
===Splenectomy=== | ===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/ | 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). | ||
[[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]] 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). | ||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Revision as of 15:56, 4 March 2013
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Idiopathic thrombocytopenic purpura Microchapters |
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Differentiating Idiopathic thrombocytopenic purpura from other Diseases |
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Idiopathic thrombocytopenic purpura surgery On the Web |
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American Roentgen Ray Society Images of Idiopathic thrombocytopenic purpura surgery |
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Directions to Hospitals Treating Idiopathic thrombocytopenic purpura |
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Risk calculators and risk factors for Idiopathic thrombocytopenic purpura surgery |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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).
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).