Yes ! Bertrand Godeau Centre de rfrence des cytopnies auto-immunes - - PowerPoint PPT Presentation
CHU Henri MONDOR ASSISTANCE PUBLIQUE HPITAUX DE PARIS Is there still a role for splenectomy in ITP? Yes ! Bertrand Godeau Centre de rfrence des cytopnies auto-immunes de ladulte Service de mdecine interne CHU Henri Mondor,
Bertrand Godeau Centre de référence des cytopénies auto-immunes de l’adulte Service de médecine interne CHU Henri Mondor, 94000 Créteil, France bertrand.godeau@hmn.aphp.fr
ASSISTANCE PUBLIQUE HÔPITAUX DE PARIS
CHU Henri MONDOR
(follow-up 1 to 153 months)
The long-term prognosis of splenectomized patients is favorable, even in the subgroup of patients who intially failed to respond to splenectomy ?
corticosteroids (91%) and second line treatment splenectomy (71%)
patients expressed concern about splenectomy (74%) or in presence of comorbidities Treatment practices in adults with chronic immune thrombocytopenia – a European perspective
Rodeghiero et al, European Journal of Haematology 2009; 84: 160-8
Short-term and long-term failure of laparoscopic splenectomy in adult immune thrombocytopenic purpura patients: a systematic review.
Mikhael et al Am J Hematol. 2009; 84:743-8.
8.2% (95% CI 5.4-11.0)
4,4 per 100 patient years (95% CI 2.8.-6.7)
Failure rate of 28% at 5 years
Splenectomy may have higher initial relapse rates, particularly, in the first 2 years after surgery, and the rate may decline over time
Time to Splenectomy Failure in Patients with Recurrent
Purpura
Gregory Cheng1*, Terry Gernsheimer, MD2, Harold J. Olney, MD, CM3, James B. Bussel, MD4, Palvi Shah5*, Andres Brainsky6*, Kelly M. Grotzinger6* and Manuel Aivado6 50% of relapse during the first yr
– Arteriothrombosis – Venous thrombosis – Cardiovascular events – Pulmonary hypertension Complications of splenectomy
Risk for hospital contact with infection in patients with splenectomy. A population-based cohort study
Thomsen et al, Ann Intern Med 2009; 151: 546-55
Risk for hospital contact with infection in patients with splenectomy. A population-based cohort study
Thomsen et al, Ann Intern Med 2009; 151: 546-55
Splenectomized ITP patients n = 269 Non splenectomized ITP patients n = 1345 Adjusted RR (95% CI) Median days since splenectomy indicated 196 196 Infection involving hospital contact 0 to 90 d, n (%) 15 (5.6) 36 (2.7) 2.6 (1.3-5.1) 91 to 365 d, n (n p 100pt yr) 11 (5.7) 59 (6.5) 1 (0.5-2) > 365 d 56 (4.6) 173 (3.3) 1.4 (1-2)
Risk for hospital contact with infection in patients with splenectomy. A population-based cohort study
Thomsen et al, Ann Intern Med 2009; 151: 546-55
ITP: hyperexpression of Cell-derived microparticles
Fontana et al, Thrombosis Research 2008; 122: 599-603
Splenectomy as a cause of Chronic Thromboembolism Pulmonary Hypertension (CTEPH) ?
Jaïs et al, Thorax 2005; 60: 1031-4
Can the results of isotopic study help the clinicans to make the decision to perform splenectomy ?
Autologous 111In-Labeled Platelet Sequestration Studies in Patients with Primary Immune Thrombocytopenia (ITP): A Report From the United Kingdom Registry
Ameet Sarpatwari, M.Phil1*, Drew Provan, MD2*, Ravin Sobnack, PhD3*, Sebhat Erqou, MD, M.Phil4*, F. W. David Tai, BSc.5*, Simon Sanderson, MD4* and Adrian Newland, MD, FRCP6