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Immune Thrombocytopenia and Response to Splenectomy in Chronic Liver Disease

Immune Thrombocytopenia and Response to Splenectomy in Chronic Liver Disease Abstract • Six patients had chronic liver diseases of diverse origin, persistent unexplained thrombocytopenia, and no palpable splenic enlargement. Platelet-associated IgG levels were increased in all cases. Two patients underwent splenectomy; the spleens weighed 375 and 230 g. Each patient had prompt, complete, and sustained platelet count normalization. Two other patients treated briefly with prednisone had no response. These observations indicate that a minimally enlarged spleen may be responsible for thrombocytopenia in chronic liver disease and suggest that immune mechanisms may contribute to thrombocytopenia in this setting. (Arch Intern Med 1986;146:555-557) References 1. Barrison IG, Knight ID, Viola L, et al: Platelet-associated immunoglobulin in chronic liver disease. Br J Haematol 1981;48:347-350.Crossref 2. Landolfi R, Leone G, Fedeli G, et al: Platelet-associated IgG in acute and chronic hepatic disease. Scand J Haematol 1980;25:417-422.Crossref 3. Leone G, Agostini A, Mango G, et al: Megathrombocytes, platelet regeneration time and platelet-associated IgG in idiopathic thrombocytopenic purpura and in thrombocytopenia associated with chronic liver disease. Acta Haematol 1981;65:40-47.Crossref 4. Kelton JG: The measurement of platelet-bound immunoglobulins: An overview of the methods and the biologic relevance to platelet-associated IgG. Prog Hematol 1983;13:163-199. 5. Kelton JG, Powers PJ, Carter CJ: A prospective study of the usefulness of the measurement of platelet-associated IgG for the diagnosis of idiopathic thrombocytopenic purpura. Blood 1982;60:1050-1053. 6. McGrath KM, Stuart JJ, Richards F: Correlation between serum IgG, platelet membrane IgG, and platelet function in hypergammaglobulinemic states. Br J Haematol 1979;42:585-591.Crossref 7. Mueller-Eckhardt C, Kayser W, Mersch-Baumert K, et al: The clinical significance of platelet-associated IgG: A study on 298 patients with various disorders. Br J Haematol 1980;46:123-131.Crossref 8. Kelton JG, Steeves K: The amount of platelet-bound albumin parallels the amount of IgG on washed platelets from patients with immune thrombocytopenia. Blood 1983;62:924-927. 9. Tan EM, Cohen AS, Fries JF, et al: 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 1982;25: 1271-1277.Crossref 10. Dixon RD, Rosse W, Ebbert L: Quantitative determination of antibody in idiopathic thrombocytopenic purpura. N Engl J Med 1975;292:230-236.Crossref 11. Ritzmann SE, Fischer CL, Nakamura RM: Quantitative immunochemical procedures , in Ritzmann SE, Daniels JC (eds): Serum Protein Abnormalities: Diagnostic and Clinical Aspects . Boston, Little Brown & Co, 1975, pp 61-69. 12. McMillan R: Chronic idiopathic thrombocytopenic purpura. N Engl J Med 1981;304:1135-1147.Crossref 13. Karpatkin S: Autoimmune thrombocytopenic purpura. Blood 1980; 56:329-343. 14. Van Leeuwen EF, van der VenJThM, Engelfriet CP, et al: Specificity of autoantibodies in autoimmune thrombocytopenia. Blood 1982;59:23-26. 15. Woods VL Jr, Oh EH, Mason D, et al: Autoantibodies against the platelet glycoprotein IIb/IIIa complex in patients with chronic ITP. Blood 1984;63:368-375. 16. Woods VL Jr, Kurata Y, Montgomery RR, et al: Autoantibodies against glycoprotein Ib in patients with chronic immune thrombocytopenic purpura. Blood 1984;64:156-160. 17. Varon D, Karpatkin S: A monoclonal anti-platelet antibody with decreased reactivity for autoimmune thrombocytopenic platelets. Proc Natl Acad Sci USA 1983;80:6992-6995.Crossref 18. Anderson MJ, Woods VL Jr, Tani P, et al: Autoantibodies to platelet glycoprotein IIb/IIIa and to the acetylcholine receptor in a patient with chronic idiopathic thrombocytopenic purpura and myasthenia gravis. Ann Intern Med 1984;100:829-831.Crossref 19. Mistilis SP, Skyring AP, Blackburn CRB: Natural history of active chronic hepatitis: I. Clinical features, course, diagnostic criteria, morbidity, mortality and survival. Aust NZ J Med 1968;17:214-223. 20. Golding PL, Smith M, Williams R: Multi-system involvement in chronic liver disease, studies on the incidence and pathogenesis. Am J Med 1973;55:772-782.Crossref 21. Panush RS, Wilkinson LS, Fagin RR: Chronic active hepatitis associated with eosinophilia and Coombs-positive hemolytic anemia. Gastroenterology 1973;64:1015-1016. 22. Salam AA: Selective distal splenorenal shunt: Technique and results , in Rutherford RB (ed): Vascular Surgery , ed 2. Philadelphia, WB Saunders Co, 1984, pp 1052-1060. 23. Krivit W: Overwhelming postsplenectomy infection. Am J Hematol 1977;1:193-201.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Immune Thrombocytopenia and Response to Splenectomy in Chronic Liver Disease

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Publisher
American Medical Association
Copyright
Copyright © 1986 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1986.00360150185023
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Abstract

Abstract • Six patients had chronic liver diseases of diverse origin, persistent unexplained thrombocytopenia, and no palpable splenic enlargement. Platelet-associated IgG levels were increased in all cases. Two patients underwent splenectomy; the spleens weighed 375 and 230 g. Each patient had prompt, complete, and sustained platelet count normalization. Two other patients treated briefly with prednisone had no response. These observations indicate that a minimally enlarged spleen may be responsible for thrombocytopenia in chronic liver disease and suggest that immune mechanisms may contribute to thrombocytopenia in this setting. (Arch Intern Med 1986;146:555-557) References 1. Barrison IG, Knight ID, Viola L, et al: Platelet-associated immunoglobulin in chronic liver disease. Br J Haematol 1981;48:347-350.Crossref 2. Landolfi R, Leone G, Fedeli G, et al: Platelet-associated IgG in acute and chronic hepatic disease. Scand J Haematol 1980;25:417-422.Crossref 3. Leone G, Agostini A, Mango G, et al: Megathrombocytes, platelet regeneration time and platelet-associated IgG in idiopathic thrombocytopenic purpura and in thrombocytopenia associated with chronic liver disease. Acta Haematol 1981;65:40-47.Crossref 4. Kelton JG: The measurement of platelet-bound immunoglobulins: An overview of the methods and the biologic relevance to platelet-associated IgG. Prog Hematol 1983;13:163-199. 5. Kelton JG, Powers PJ, Carter CJ: A prospective study of the usefulness of the measurement of platelet-associated IgG for the diagnosis of idiopathic thrombocytopenic purpura. Blood 1982;60:1050-1053. 6. McGrath KM, Stuart JJ, Richards F: Correlation between serum IgG, platelet membrane IgG, and platelet function in hypergammaglobulinemic states. Br J Haematol 1979;42:585-591.Crossref 7. Mueller-Eckhardt C, Kayser W, Mersch-Baumert K, et al: The clinical significance of platelet-associated IgG: A study on 298 patients with various disorders. Br J Haematol 1980;46:123-131.Crossref 8. Kelton JG, Steeves K: The amount of platelet-bound albumin parallels the amount of IgG on washed platelets from patients with immune thrombocytopenia. Blood 1983;62:924-927. 9. Tan EM, Cohen AS, Fries JF, et al: 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 1982;25: 1271-1277.Crossref 10. Dixon RD, Rosse W, Ebbert L: Quantitative determination of antibody in idiopathic thrombocytopenic purpura. N Engl J Med 1975;292:230-236.Crossref 11. Ritzmann SE, Fischer CL, Nakamura RM: Quantitative immunochemical procedures , in Ritzmann SE, Daniels JC (eds): Serum Protein Abnormalities: Diagnostic and Clinical Aspects . Boston, Little Brown & Co, 1975, pp 61-69. 12. McMillan R: Chronic idiopathic thrombocytopenic purpura. N Engl J Med 1981;304:1135-1147.Crossref 13. Karpatkin S: Autoimmune thrombocytopenic purpura. Blood 1980; 56:329-343. 14. Van Leeuwen EF, van der VenJThM, Engelfriet CP, et al: Specificity of autoantibodies in autoimmune thrombocytopenia. Blood 1982;59:23-26. 15. Woods VL Jr, Oh EH, Mason D, et al: Autoantibodies against the platelet glycoprotein IIb/IIIa complex in patients with chronic ITP. Blood 1984;63:368-375. 16. Woods VL Jr, Kurata Y, Montgomery RR, et al: Autoantibodies against glycoprotein Ib in patients with chronic immune thrombocytopenic purpura. Blood 1984;64:156-160. 17. Varon D, Karpatkin S: A monoclonal anti-platelet antibody with decreased reactivity for autoimmune thrombocytopenic platelets. Proc Natl Acad Sci USA 1983;80:6992-6995.Crossref 18. Anderson MJ, Woods VL Jr, Tani P, et al: Autoantibodies to platelet glycoprotein IIb/IIIa and to the acetylcholine receptor in a patient with chronic idiopathic thrombocytopenic purpura and myasthenia gravis. Ann Intern Med 1984;100:829-831.Crossref 19. Mistilis SP, Skyring AP, Blackburn CRB: Natural history of active chronic hepatitis: I. Clinical features, course, diagnostic criteria, morbidity, mortality and survival. Aust NZ J Med 1968;17:214-223. 20. Golding PL, Smith M, Williams R: Multi-system involvement in chronic liver disease, studies on the incidence and pathogenesis. Am J Med 1973;55:772-782.Crossref 21. Panush RS, Wilkinson LS, Fagin RR: Chronic active hepatitis associated with eosinophilia and Coombs-positive hemolytic anemia. Gastroenterology 1973;64:1015-1016. 22. Salam AA: Selective distal splenorenal shunt: Technique and results , in Rutherford RB (ed): Vascular Surgery , ed 2. Philadelphia, WB Saunders Co, 1984, pp 1052-1060. 23. Krivit W: Overwhelming postsplenectomy infection. Am J Hematol 1977;1:193-201.Crossref

Journal

Archives of Internal Medicine – American Medical Association

Published: Mar 1, 1986

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