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Splenectomy: The Treatment of Choice for Human Immunodeficiency Virus–Related Immune Thrombocytopenia?

Splenectomy: The Treatment of Choice for Human Immunodeficiency Virus–Related Immune... Abstract • Immune thrombocytopenia is a well-recognized part of the clinical spectrum of infection with the human immunodeficiency virus. From November 1985 to February 1988, 15 patients who were human immunodeficiency virus–positive underwent splenectomy for refractory immune thrombocytopenia. Eight patients had thrombocytopenia only, and 7 others were pancytopenic prior to splenectomy. Three of the 15 patients fulfilled criteria for acquired immunodeficiency syndrome before splenectomy, and acquired immunodeficiency syndrome developed in 5 patients during the follow-up period. The median duration of thrombocytopenia prior to surgical therapy was 6 months. A bone marrow biopsy specimen showed hypercellularity with increased megakaryocytes. All patients had a therapeutic response to splenectomy. Long-term remission from thrombocytopenia/pancytopenia was achieved in 14 of the 15 patients during a follow-up period of 2 to 21 months. Splenectomy can be accomplished with an acceptable morbidity. Pneumonia developed postoperatively in 2 patients, but they did not manifest the characteristic picture of overwhelming postsplenectomy sepsis. They had received vaccinations against encapsulated organisms preoperatively. We conclude that splenectomy provides a durable and lasting response for HIV-related thrombocytopenia. Vaccination for Streptococcus pneumonia and Haemophilus influenzae should be given prior to splenectomy although its efficacy is not clear in this group. (Arch Surg. 1989;124:625-628) References 1. Ho DD, Pomerantz RJ, Kaplan JC. Pathogenesis of infection with human immunodeficiency virus . N Engl J Med . 1987;317:278-286.Crossref 2. Lane HC, Masur H, Gelman ER, et al. Correlation between immunologic function and clinical subpopulations of patients with the acquired immunodeficiency syndrome . Am J Med . 1985;78:417-422.Crossref 3. Donohue RE, Johnson MM, Zon LI, Clark SC, Groopman JE. Suppression of in vitro hematopoiesis following HIV infection . Nature . 1987; 326:200-203.Crossref 4. Selwyn PA. AIDS: what is now known, III: clinical aspects . Hosp Pract Off 1986;21:119-153. 5. Walsh CM, Nardi MA, Karpatkin S. On the mechanism of thrombocytopenic purpura in sexually active homosexual men . N Engl J Med . 1984;311:635-639.Crossref 6. Schwartz SI. Splenectomy for thrombocytopenia . World J Surg . 1985; 9:416-421.Crossref 7. Stricken RB, Abrams DI, Corash L, Shuman MA. Target platelet antigen in homosexual men with immune thrombocytopenia . N Engl J Med . 1985;313:1375-1380.Crossref 8. Ordi J, Vilardell M, Alijotas J, Barquinero J, Vila M. Serum thrombocytopenia and high-dose immunoglobulin treatment . Ann Intern Med . 1986; 104:282-283.Crossref 9. Bussel JB, Kimberly RP, Inman RD, et al. Intravenous gammaglobulin treatment of clinical ITP . Blood . 1983;62:480-486. 10. Newland AC, Treleaver JG, Minchinton RM, Waters AH. High-dose IV IgG in adults with autoimmune thrombocytopenia . Lancet . 1983;1:84-87.Crossref 11. Tertian G, Risler N, LeBras P, et al. Intravenous gammaglobulin treatment for thrombocytopenic purpura in patients with HIV infection . Eur J Haematol . 1987;39:180-181.Crossref 12. Fischl M, Ahn YS, Klimas N, et al. Use of danazol in autoimmune thrombocytopenia associated with AIDS. Presented at the International Conference on AIDS; April 14, 1985; Atlanta, Ga. 13. Ahn YS, Harrington WJ, Simon SR, Mylvaganam R, Pall LM, So AG. Danazol for the treatment of idiopathic thrombocytopenia purpura . N Engl J Med . 1983;308:1396-1399.Crossref 14. Schreiber AD, Chien P, Tomaski A, Cines DB. Effect of danazol in immune thrombocytopenic purpura . N Engl J Med . 1987;316:503-508.Crossref 15. Real FX, Krown SE. Spontaneous regression of Kaposi's sarcoma in patients with AIDS . N Engl J Med . 1985;313:1659. 16. Shafer RW, Offit K, Macrus NT, et al. Possible risk of steroid administration in patients at risk for AIDS . Lancet . 1985;934-935. 17. Abrams DI, Kiprov DD, Goedert JJ, Sarngadharan MG, Gallo RC, Volberding PA. Antibodies to human T-lymphotrophic virus type III and development of the acquired immunodeficiency syndrome in homosexual men presenting with immune thrombocytopenia . Ann Intern Med . 1986; 104:47-50.Crossref 18. Cohen AJ, Philips TM, Kessler CM. Circulating coagulation inhibitors in the acquired immunodeficiency syndrome . Ann Intern Med . 1986; 104:175-180.Crossref 19. Ferguson CM. Surgical complications of human immunodeficiency virus infection . Am Surg . 1988;54:4-9. 20. Rosenfeld FP, Rosenblood BE, Weinstein IM. Thrombocytopenia in homosexual men . Ann Intern Med . 1987;106:911-913.Crossref 21. Barbui T, Cortelazzo S, Minetti B, Galli M, Buelli M. Does splenectomy enhance risk of AIDS in HIV positive patients with chronic thrombocytopenia? Lancet . 1987;2:342-343.Crossref 22. Dickerman JD. Splenectomy and sepsis: a warning . Pediatrics . 1979; 63:938-941. 23. Ammann AJ, Schiffman G, Abrams D, Volberding P, Zigler J, Conant M. B-cell immunodeficiency in acquired immune deficiency syndrome . JAMA . 1984;251:1447-1449.Crossref 24. Bowen DL, Lane HC, Fauci AS. Immunopathogenesis of the acquired immunodeficiency syndrome . Ann Intern Med . 1985;103:704-709.Crossref 25. Polsky B, Gold JWM, Whimbey E, et al. Bacterial pneumonia in patients with the acquired immunodeficiency syndrome . Ann Intern Med . 1986;104:38-41.Crossref 26. Walsh C, Krigel R, Lennette E, Karpatkin S: Thrombocytopenia in homosexual patients . Ann Intern Med . 1985;103:542-545.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Splenectomy: The Treatment of Choice for Human Immunodeficiency Virus–Related Immune Thrombocytopenia?

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References (31)

Publisher
American Medical Association
Copyright
Copyright © 1989 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1989.01410050115022
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Abstract

Abstract • Immune thrombocytopenia is a well-recognized part of the clinical spectrum of infection with the human immunodeficiency virus. From November 1985 to February 1988, 15 patients who were human immunodeficiency virus–positive underwent splenectomy for refractory immune thrombocytopenia. Eight patients had thrombocytopenia only, and 7 others were pancytopenic prior to splenectomy. Three of the 15 patients fulfilled criteria for acquired immunodeficiency syndrome before splenectomy, and acquired immunodeficiency syndrome developed in 5 patients during the follow-up period. The median duration of thrombocytopenia prior to surgical therapy was 6 months. A bone marrow biopsy specimen showed hypercellularity with increased megakaryocytes. All patients had a therapeutic response to splenectomy. Long-term remission from thrombocytopenia/pancytopenia was achieved in 14 of the 15 patients during a follow-up period of 2 to 21 months. Splenectomy can be accomplished with an acceptable morbidity. Pneumonia developed postoperatively in 2 patients, but they did not manifest the characteristic picture of overwhelming postsplenectomy sepsis. They had received vaccinations against encapsulated organisms preoperatively. We conclude that splenectomy provides a durable and lasting response for HIV-related thrombocytopenia. Vaccination for Streptococcus pneumonia and Haemophilus influenzae should be given prior to splenectomy although its efficacy is not clear in this group. (Arch Surg. 1989;124:625-628) References 1. Ho DD, Pomerantz RJ, Kaplan JC. Pathogenesis of infection with human immunodeficiency virus . N Engl J Med . 1987;317:278-286.Crossref 2. Lane HC, Masur H, Gelman ER, et al. Correlation between immunologic function and clinical subpopulations of patients with the acquired immunodeficiency syndrome . Am J Med . 1985;78:417-422.Crossref 3. Donohue RE, Johnson MM, Zon LI, Clark SC, Groopman JE. Suppression of in vitro hematopoiesis following HIV infection . Nature . 1987; 326:200-203.Crossref 4. Selwyn PA. AIDS: what is now known, III: clinical aspects . Hosp Pract Off 1986;21:119-153. 5. Walsh CM, Nardi MA, Karpatkin S. On the mechanism of thrombocytopenic purpura in sexually active homosexual men . N Engl J Med . 1984;311:635-639.Crossref 6. Schwartz SI. Splenectomy for thrombocytopenia . World J Surg . 1985; 9:416-421.Crossref 7. Stricken RB, Abrams DI, Corash L, Shuman MA. Target platelet antigen in homosexual men with immune thrombocytopenia . N Engl J Med . 1985;313:1375-1380.Crossref 8. Ordi J, Vilardell M, Alijotas J, Barquinero J, Vila M. Serum thrombocytopenia and high-dose immunoglobulin treatment . Ann Intern Med . 1986; 104:282-283.Crossref 9. Bussel JB, Kimberly RP, Inman RD, et al. Intravenous gammaglobulin treatment of clinical ITP . Blood . 1983;62:480-486. 10. Newland AC, Treleaver JG, Minchinton RM, Waters AH. High-dose IV IgG in adults with autoimmune thrombocytopenia . Lancet . 1983;1:84-87.Crossref 11. Tertian G, Risler N, LeBras P, et al. Intravenous gammaglobulin treatment for thrombocytopenic purpura in patients with HIV infection . Eur J Haematol . 1987;39:180-181.Crossref 12. Fischl M, Ahn YS, Klimas N, et al. Use of danazol in autoimmune thrombocytopenia associated with AIDS. Presented at the International Conference on AIDS; April 14, 1985; Atlanta, Ga. 13. Ahn YS, Harrington WJ, Simon SR, Mylvaganam R, Pall LM, So AG. Danazol for the treatment of idiopathic thrombocytopenia purpura . N Engl J Med . 1983;308:1396-1399.Crossref 14. Schreiber AD, Chien P, Tomaski A, Cines DB. Effect of danazol in immune thrombocytopenic purpura . N Engl J Med . 1987;316:503-508.Crossref 15. Real FX, Krown SE. Spontaneous regression of Kaposi's sarcoma in patients with AIDS . N Engl J Med . 1985;313:1659. 16. Shafer RW, Offit K, Macrus NT, et al. Possible risk of steroid administration in patients at risk for AIDS . Lancet . 1985;934-935. 17. Abrams DI, Kiprov DD, Goedert JJ, Sarngadharan MG, Gallo RC, Volberding PA. Antibodies to human T-lymphotrophic virus type III and development of the acquired immunodeficiency syndrome in homosexual men presenting with immune thrombocytopenia . Ann Intern Med . 1986; 104:47-50.Crossref 18. Cohen AJ, Philips TM, Kessler CM. Circulating coagulation inhibitors in the acquired immunodeficiency syndrome . Ann Intern Med . 1986; 104:175-180.Crossref 19. Ferguson CM. Surgical complications of human immunodeficiency virus infection . Am Surg . 1988;54:4-9. 20. Rosenfeld FP, Rosenblood BE, Weinstein IM. Thrombocytopenia in homosexual men . Ann Intern Med . 1987;106:911-913.Crossref 21. Barbui T, Cortelazzo S, Minetti B, Galli M, Buelli M. Does splenectomy enhance risk of AIDS in HIV positive patients with chronic thrombocytopenia? Lancet . 1987;2:342-343.Crossref 22. Dickerman JD. Splenectomy and sepsis: a warning . Pediatrics . 1979; 63:938-941. 23. Ammann AJ, Schiffman G, Abrams D, Volberding P, Zigler J, Conant M. B-cell immunodeficiency in acquired immune deficiency syndrome . JAMA . 1984;251:1447-1449.Crossref 24. Bowen DL, Lane HC, Fauci AS. Immunopathogenesis of the acquired immunodeficiency syndrome . Ann Intern Med . 1985;103:704-709.Crossref 25. Polsky B, Gold JWM, Whimbey E, et al. Bacterial pneumonia in patients with the acquired immunodeficiency syndrome . Ann Intern Med . 1986;104:38-41.Crossref 26. Walsh C, Krigel R, Lennette E, Karpatkin S: Thrombocytopenia in homosexual patients . Ann Intern Med . 1985;103:542-545.Crossref

Journal

Archives of Surgery – American Medical Association

Published: May 1, 1989

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