Osteonecrosis in a patient with immune thrombocytopenic purpura

Smith, Roy E.; Chelmowski, Mark K.; Anderson, Tom

doi:10.1002/ajh.2830260113

Cited by 5 publications

(2 citation statements)

References 8 publications

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“…As our data about adverse vascular events come only from families with hereditary spherocytosis, we searched Medline for reports of adverse vascular events occurring more than 1 month after splenectomy, regardless of the indication for surgery. We found 80 citations [1,7–85] documenting nine different, although not necessarily independent, adverse vascular events after splenectomy performed for more than 14 different indications. (A tabulation of these data is available via e‐mail request to RFS.…”

Section: Discussionmentioning

confidence: 99%

Delayed adverse vascular events after splenectomy in hereditary spherocytosis

Schilling

Gangnon

Traver

2008

Journal of Thrombosis and Haemostasis

103

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To cite this article: Schilling RF, Gangnon RE, Traver MI. Delayed adverse vascular events after splenectomy in hereditary spherocytosis. J Thromb Haemost 2008; 6: 1289-95.Summary. Background: It is probable that the variety and frequency of delayed adverse vascular events after splenectomy are underappreciated. Splenectomy is performed for a wide variety of conditions, and delayed postsplenectomy hazards are not often studied. Objective: To estimate the relative risk of adverse vascular events in members of hereditary spherocytosis families who have or have not had a splenectomy. Methods: Members of families in which hereditary spherocytosis exists were systematically questioned about adverse vascular events. Results: The cumulative incidence of arterial and venous events at age 70 years was greater in persons who had undergone a splenectomy for spherocytosis (arterial, 22% females, 32% males; venous, 20% females, 19% males) than in affected persons who did not undergo splenectomy (arterial, 3% females, 2% males; venous, 6% females, 4% males) or non-affected family members (arterial, 10% females, 17% males; venous, 4% females, 12% males). Affected subjects who undergo splenectomy are at greatly increased risk of arterial events as compared to affected subjects who do not undergo splenectomy [arterial, hazard ratio (HR) 7.2, 95% confidence interval (CI) 2.8-17.2; venous, HR 3.3, 95% CI 1.1-9.8]. Conclusion: There is a significant, long-lasting, increased risk of adverse arterial and venous thromboembolic events after splenectomy performed for hereditary spherocytosis. A review of the literature indicates that this is also true when splenectomy is performed for several other indications.

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Section: Discussionmentioning

confidence: 99%

Delayed adverse vascular events after splenectomy in hereditary spherocytosis

Schilling

Gangnon

Traver

2008

Journal of Thrombosis and Haemostasis

103

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“…[2][3][4][5][6][7][8][9] Treatment with corticosteroids is another risk factor in the pathogenesis of osteonecrosis as first mentioned in 1950. 10 Therefore, avascular necrosis is a well-described complication after renal and cardiac transplantation, especially in patients receiving high-dose steroids for graft rejection.…”

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confidence: 99%

Avascular necrosis of bone following allogeneic stem cell transplantation: MR screening and therapeutic options

Wiesmann

Pereira

Böhm

et al. 1998

Bone Marrow Transplant

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Summary:With improvement in long-term survival after allogeneic stem cell transplantation, late complications with significant morbidity are of increasing importance. We retrospectively analysed 272 recipients of an allogeneic stem cell transplant for the development of osteonecrosis. The incidence among allograft recipients was 6.3% (17/272) for the whole patient population, and 11.8% (17/144) for long-term survivors. All patients were treated with high-dose prednisolone, 16 for severe acute or extensive chronic graft-versus-host disease (GVHD) and one patient for graft rejection. The mean age at time of diagnosis was 33 years (range 16-45) and the mean time from transplant to diagnosis of osteonecrosis was 13 months. Osteonecrosis was diagnosed by magnetic resonance (MR) imaging, which allows early detection of osteonecrosis and assessment of stage. At the time of diagnosis, eight patients had stage I, three patients stage II, three patients stage III and three patients stage IV osteonecrosis according to MR criteria. All but one patient had involvement of the femoral head. The median total dosage of prednisolone at the time of diagnosis was 189 mg/kg (single manifestation 150 mg/kg; multiple manifestations 313 mg/kg) with a total range of 13-555 mg/kg. Six patients were treated by conservative means, 77 patients underwent surgery (three core decompression, eight joint replacement). MR screening of patients receiving highdose steroids might help to detect osteonecrosis at an early stage and thus prevent progression by early intervention, for example, by core decompression. Keywords: avascular necrosis; allogeneic stem cell transplantation; magnetic resonance-steroids With improvement in long-term survival after allogeneic bone marrow transplantation, late complications with significant morbidity are of increasing importance.Osteonecrosis is a general term applied to conditions resulting in necrosis of bone and marrow elements. Avascular necrosis indicates involvement of the epiphysis or subCorrespondence: Dr H Einsele, Department of Hematology and Oncology, University of Tübingen, Otfried Müller Str. 10, 72076 Tübingen, Germany Received 9 March 1998; accepted 20 April 1998 chondral bone, whereas osteonecrosis of the metaphyseal or diaphyseal bone is commonly referred to as bone infarct.

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The comparison of gammaglobulin to steroids in treating adult immune thrombocytopenia

Jacobs

Wood

1989

Blut

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Symptomatic immune thrombocytopenia is a life-threatening situation which is conventionally treated in the adult with prednisone, although subsequent splenectomy is frequently unavoidable. Recently, high-dose intravenous gamma-globulin has been reported to be an effective alternative option, particularly in children. To determine the role of this agent in adults a controlled prospective trial has been undertaken. Previously untreated patients with immune thrombocytopenia were randomised to compare oral prednisone (1 mg/kg/day: Group 1: n = 13) to high-dose intravenous gamma-globulin (400 mg/kg on days 1 through 5: Group 2: n = 7), or a combination of both agents given on the same schedule (Group 3: n = 12). The time from diagnosis to commencement of treatment, initial platelet counts, age and sex were comparable in the three groups. At this interim analysis there has been no mortality, but one patient has suffered a cerebrovascular accident. Objective response, defined as a platelet count greater than 50 x 10(9)/l, was achieved in a median of 5, 5 and 3 days, whereas the time taken to reach peak counts were 9, 5 and 7 days, respectively. The relapse rates, percentage of patients subsequently requiring splenectomy for control of symptomatic bleeding and the postoperative course was comparable between the three groups. These data, although preliminary, re-emphasize differences between the paediatric and adult forms of immune thrombocytopenia and also suggest in the latter patients a need for caution before advocating replacement of prednisone by gammaglobulin as the primary form of treatment.

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Osteonecrosis in a patient with immune thrombocytopenic purpura

Abstract: We report a case of osteonecrosis in a 26-year-old woman treated with prednisone for immune thrombocytopenic purpura. The unusual complication occurred after a much shorter course of steroids of a considerably smaller cumulative dose than in previously reported cases.

Cited by 5 publications

References 8 publications

Delayed adverse vascular events after splenectomy in hereditary spherocytosis

Delayed adverse vascular events after splenectomy in hereditary spherocytosis

Avascular necrosis of bone following allogeneic stem cell transplantation: MR screening and therapeutic options

The comparison of gammaglobulin to steroids in treating adult immune thrombocytopenia

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