Effects of prednisone and splenectomy in patients with idiopathic thrombocytopenic purpura: only splenectomy induces a complete remission

Louwes, H; Vellenga, Edo; Houwerzijl, EJ; Wolf, de Joseph

doi:10.1007/s002770100375

Cited by 19 publications

(18 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Previous studies have shown that prednisone improves the platelet count in ITP primarily by increasing platelet production [9,10]. The present findings are consistent with these results by showing that ITP patients with the lowest PPR are the most likely to respond to prednisone in the long term.…”

Section: Discussionsupporting

confidence: 92%

“…In keeping with these findings are platelet kinetic studies using radioactive indium ( 111 In), which have shown that splenectomy improves the platelet counts predominantly by increasing platelet survival [9,10]. In these studies [9,10], prednisone primarily affected the platelet production, which contradicted earlier radiolabeled platelet studies using chromium-51 ( 51 Cr), suggesting that successful response to prednisone was caused by an increase in platelet survival [11]. In the present study, we investigated the predictive value of thrombokinetic and clinical parameters in 75 adult patients with severe ITP.…”

Section: Introductionmentioning

confidence: 71%

“…Siegel et al [8] showed that an increased PPR in conjunction with a short platelet survival correlated with a favorable response to splenectomy, while patients with a reduced PPR and a moderately reduced survival demonstrated a poor outcome following splenectomy. In keeping with these findings are platelet kinetic studies using radioactive indium ( 111 In), which have shown that splenectomy improves the platelet counts predominantly by increasing platelet survival [9,10]. In these studies [9,10], prednisone primarily affected the platelet production, which contradicted earlier radiolabeled platelet studies using chromium-51 ( 51 Cr), suggesting that successful response to prednisone was caused by an increase in platelet survival [11].…”

Section: Introductionmentioning

confidence: 94%

See 2 more Smart Citations

Platelet production rate predicts the response to prednisone therapy in patients with idiopathic thrombocytopenic purpura

et al. 2008

View full text Add to dashboard Cite

The predictive value of clinical and platelet kinetic parameters for treatment outcome in idiopathic thrombocytopenic purpura (ITP) was investigated in 75 patients with platelets ≤20×10 9 /L. The platelet kinetic studies showed that the platelet production rate (PPR) was decreased (<100×10 9 /day), normal, or increased (>355×10 9 /day) in 33%, 48%, and 19% of patients, respectively. All patients started with prednisone at diagnosis (1 mg/kg/day). Initial complete and partial response (CR/PR) rate was 84% and a durable CR/PR (≥6 months without treatment) was attained in 44% of the patients. Durable CR/PR was noticed in 64% of the patients with decreased PPR during a median followup time without treatment of 81 (range 18-92) months, compared to 34% of the patients with normal or increased PPR during a median follow-up time without treatment of 141 (range 10-284) months (p=0.03). Splenectomy was performed in 32% of patients with decreased PPR and in 62% of patients with normal or increased PPR (p=0.03). In conclusion, ITP patients with suppressed PPR have a significant higher durable CR/PR rate to prednisone therapy and are less frequently exposed to splenectomy than those with a normal or increased PPR.

show abstract

Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 71%

Section: Introductionmentioning

confidence: 94%

See 1 more Smart Citation

Platelet production rate predicts the response to prednisone therapy in patients with idiopathic thrombocytopenic purpura

et al. 2008

View full text Add to dashboard Cite

show abstract

“…Moreover, there are many reports about a reduced PPR in a subgroup (30% to 50%) of ITP patients. 4,5,6,39,40 Experiments in which thrombokinetic studies were repeated after splenectomy and prednisone treatment showed that both forms of treatment can induce a distinct increase in PPR, 41 indicating that the release of platelets to the circulation (ie, PPR) in active ITP is relatively depressed, perhaps due to the action of autoantibodies directed against megakaryocytes.Besides the results of reduced platelet production in platelet kinetic studies, the present study gives additional evidence for reduced platelet production by injured megakaryocytes. In a recent study 13 we observed a significant inverse correlation between the PPR and the glycocalicin index (GCI) in ITP patients.…”

mentioning

confidence: 99%

Ultrastructural study shows morphologic features of apoptosis and para-apoptosis in megakaryocytes from patients with idiopathic thrombocytopenic purpura

Houwerzijl

Blom

Want

et al. 2004

Blood

257

224

View full text Add to dashboard Cite

To investigate whether altered megakaryocyte morphology contributes to reduced platelet production in idiopathic thrombocytopenic purpura (ITP), ultrastructural analysis of megakaryocytes was performed in 11 ITP patients. Ultrastructural abnormalities compatible with (para-)apoptosis were present in 78% ؎ 14% of ITP megakaryocytes, which could be reversed by in vivo treatment with prednisone and intravenous immunoglobulin. Immunohistochemistry of bone marrow biopsies of ITP patients with extensive apoptosis showed an increased number of megakaryocytes with activated caspase-3 com- IntroductionIdiopathic, or immune, thrombocytopenic purpura (ITP) is an autoimmune disease characterized by isolated thrombocytopenia in an otherwise healthy person. The thrombocytopenia in ITP is caused by accelerated platelet destruction due to the action of antiplatelet immunoglobulin G (IgG) autoantibodies that bind to antigens on the platelet cell membrane. The platelets are subsequently destroyed by tissue macrophages, predominantly in the spleen. 1 As a result of the accelerated destruction, platelet survival is usually greatly shortened and platelet production is thought to be compensatorily increased. 2,3 However, there is also evidence that platelet production can be impaired in ITP. This was demonstrated in platelet kinetic studies using radiolabeled platelets. [4][5][6] The reduced platelet production rate might be mediated by the action of antiplatelet antibodies, which can bind to megakaryocytes in the bone marrow. [7][8][9] Recent in vitro studies support this concept showing that human megakaryocyte colony formation and proplatelet formation is inhibited 10 and that a reduced expansion of megakaryocytic progenitors can be observed especially in the presence of certain antiplatelet glycoprotein antibodies. 11 However, despite the evidence of a reduced platelet production in several ITP patients, numbers of megakaryocytes in the bone marrow are usually normal or increased. 6 This is compatible with the finding that plasma thrombopoietin (TPO) levels in ITP patients are not significantly different from healthy controls, indicating that the total megakaryocytic mass has not been changed in ITP. Investigating the relationship between thrombokinetic parameters and the glycocalicin index (GCI), a parameter of platelet destruction, 12 we recently demonstrated that there is an inverse correlation between the platelet production rate and the GCI. 13 These results suggest that despite the normal number of megakaryocytes in the bone marrow an increased destruction of platelets and/or megakaryocytes might occur. These findings support the concept of ineffective thrombopoiesis in the bone marrow. To investigate whether apoptosis or other forms of programmed cell death are responsible for this ineffective thrombopoiesis, we examined the ultrastructure of bone marrow megakaryocytes from ITP patients with electron microscopy. The results demonstrate that, independent of the refractoriness of ITP to therapy, in all patients most bone ma...

show abstract

“…Even though major disadvantages of splenectomy include rare but serious postoperative infections (5), the financial burden, and perioperative risks, splenectomy seemed similar to steroid therapy in that both therapies are palliative rather than curative. Complete remission of the disease, defined by platelet count, mean platelet life, and platelet production, is reportedly obtained only after splenectomy and not after prednisone treatment (6). The laparoscopic approach was selected because this induces less damageto abdominal muscle than the laparotomy approach.…”

mentioning

confidence: 99%

Preference of Laparoscopic Splenectomy over Steroid Therapy in a Young Field Athlete with Immune Thrombocytopenic Purpura.

Kubo¹,

Nishida²,

Takagi³

et al. 2002

Intern. Med.

View full text Add to dashboard Cite

Eventhough the success ratio of the splenectomyis equal to that of steroid therapy (1), and splenectomy (2), including that by the laparoscopic method (3, 4) has recently been reported to be effective, splenectomy is not generally selected as the first choice of therapy for immunethrombocytopenic purpura. On October 16, 1995, we performed a laparoscopic splenectomy in preference to steroid therapy on a 15-year-old male field athlete with immunethrombocytopenic purpura. His platelet count on March 29, 2001 was 217,000/mm3 (217x107/) which confirmed our selection of laparoscopic splenectomy instead of the more commonsteroid therapy. The patient presented at our hospital with thrombocytopenia and nasal bleeding. Incidentally, platelet counts 3 months before his admission were 23,000-30,000/mm3 (23-30x107/). Nasal bleeding occurred occasionally, such as after afternoon exercise on the track or after taking a bath, and was difficult to stop. Other than positive platelet associated IgG and low platelet counts, the results of the patient's hematological tests were normal. The chronic nature of his thrombocytopenia was reflected in the commentof a local practitioner who noted that 1 year before the boy's visit to our hospital, his platelet count was"only 60,000/mm3 (60x107/)." In addition to being a member of the track and field club of his school, he was a record holder of the 200-meter sprint in his prefecture (Saitama Prefecture with population of 6 million). Because of his athletic aspirations, he and his parents were reluctant for him to undergo steroid therapy. Even though major disadvantages of splenectomy include rare but serious postoperative infections (5), the financial burden, and perioperative risks, splenectomy seemed similar to steroid therapy in that both therapies are palliative rather than curative. Complete remission of the disease, defined by platelet count, mean platelet life, and platelet production, is reportedly obtained only after splenectomy and not after prednisone treatment (6). The laparoscopic approach was selected because this induces less damageto abdominal muscle than the laparotomy approach. After the patient's parents gave informed consent, laparoscopic splenectomy following administration of high doses of immunoglobulin was performed under general anesthesia. The operation lasted for 7 hours and 30 minutes. Although this was significantly longer than expected, the spleen was completely resected without any dissemination within the abdominal cavity that might lead to accessory spleen formation. However, bleeding from splenic artery could not be stopped endoscopically, leading to partial abdominal fenestration. An unscheduled blood transfusion of 1,000 ml was necessary and, the admission period was 15 days 5 days longer than had been anticipated. The hospital fee (the patient's family is responsible for 30%and the health insurance system covers 70%) amounted to 540, 1 80 yen (equivalent to approximately US$5,000). At the beginning of the year, he resumed warm-up practices for sprinting ...

show abstract

Effects of prednisone and splenectomy in patients with idiopathic thrombocytopenic purpura: only splenectomy induces a complete remission

Cited by 19 publications

References 9 publications

Platelet production rate predicts the response to prednisone therapy in patients with idiopathic thrombocytopenic purpura

Platelet production rate predicts the response to prednisone therapy in patients with idiopathic thrombocytopenic purpura

Ultrastructural study shows morphologic features of apoptosis and para-apoptosis in megakaryocytes from patients with idiopathic thrombocytopenic purpura

Preference of Laparoscopic Splenectomy over Steroid Therapy in a Young Field Athlete with Immune Thrombocytopenic Purpura.

Contact Info

Product

Resources

About