Idiopathic thrombocytopenic purpura surgery: Difference between revisions
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Revision as of 20:10, 23 June 2016
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Idiopathic thrombocytopenic purpura Microchapters |
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Differentiating Idiopathic thrombocytopenic purpura from other Diseases |
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Diagnosis |
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Treatment |
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Case Studies |
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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]
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).
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).