Splenectomy in human immunodeficiency virus-related thrombocytopenia

Abstract

To evaluate the efficacy and safety of splenectomy in patients with human immunodeficiency virus (HIV)-related thrombocytopenia, 30 HIV-infected patients with thrombocytopenia (platelet count < 50 x 10(9)/l) who underwent splenectomy were followed prospectively for a mean period of 42 months. There were no perioperative deaths and morbidity was minimal. Twenty-one patients had a persistent complete response, six had a partial response and were asymptomatic after splenectomy, and only three showed no response. Three patients developed acquired immune deficiency syndrome during follow-up, an incidence that was no different from that expected. Splenectomy is a safe and effective treatment in HIV-infected patients with severe symptomatic thrombocytopenic purpura resistant to medical therapy.

Splenectomy for HIV-Related Immune Thrombocytopenia

“…Two previously published series have detailed long-term follow-up information. 15,16 After a mean follow-up of 70 months in the largest series, only 8 (12%) of 68 patients had relapsed, 15 while only 3 of 30 patients had platelets less than 50ϫ10 9 /L after a mean of 42 months after splenectomy in the other large study. 16 Splenectomy is effective treatment for classic chronic ITP in the non-HIV general population, and is indicated in cases of severe thrombocytopenia that have been refractory to medical therapy for some time.…”

“…The excellent results for splenectomy for HIVrelated thrombocytopenia in this study are similar to those of other studies. 2,[11][12][13][14][15][16][17] Combining the results for the 8 largest previously published series 2,[11][12][13][14][15][16][17] shows that splenectomy provided an early elevation of the platelet count to above 100ϫ10 9 /L in 127 (91%) of the total 140 patients in those series, and an elevation to above 50ϫ10 9 /L in another 3% of patients. Two previously published series have detailed long-term follow-up information.…”

“…Splenectomy is effective long-term therapy for patients with classic chronic ITP, 8,9 and despite concerns that splenectomy in HIV-infected patients might increase the risk of developing AIDS 10 or overwhelming postsplenectomy sepsis, splenectomy has been successfully used for the treatment of HIV-related thrombocytopenia. 2,[11][12][13][14][15][16][17] Other similarities between ITP and HIV-related thrombocytopenia include the finding of increased titers of antiplatelet antibodies in both conditions, suggesting that in HIV-related thrombocytopenia, as in classic ITP, increased removal of antibody-labeled (opsonized) platelets is a fundamental mechanism of the thrombocytopenia. 15,16,18 Normal or increased numbers of mega-karyocytes are seen in the bone marrow in both conditions, and the spleen is typically of normal size in both conditions.…”

“…2,[11][12][13][14][15][16][17] Other similarities between ITP and HIV-related thrombocytopenia include the finding of increased titers of antiplatelet antibodies in both conditions, suggesting that in HIV-related thrombocytopenia, as in classic ITP, increased removal of antibody-labeled (opsonized) platelets is a fundamental mechanism of the thrombocytopenia. 15,16,18 Normal or increased numbers of mega-karyocytes are seen in the bone marrow in both conditions, and the spleen is typically of normal size in both conditions. 19 There are differences between the 2 diseases, however.…”

Hyposplenism from Mycobacterium avium Complex Infection in a Patient with AIDS and Immune Thrombocytopenia

“…Although one can argue that our patient had a delayed response to splenectomy, we postulate that splenic hypofunction secondary to overwhelming MAC infection most likely contributed to the failure of the thrombocytopenia to promptly respond to splenectomy. From a literature search of HIV-related ITP patients who underwent splenectomy, we identified 229 patients [10, 11, 12, 13, 14, 15, 16]. Histology of the spleen was provided in 64 (27.9%) patients and none showed splenic involvement with MAC.…”