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Steroid Responsiveness: A Predictor of the Outcome of Splenectomy in Children With Chronic Immune Thrombocytopenic Purpura

Steroid Responsiveness: A Predictor of the Outcome of Splenectomy in Children With Chronic Immune... Abstract • Splenectomy is curative for many children with chronic immune thrombocytopenic purpura (ITP), but not without placing them at increased risk for serious infections. To determine the reliability of a trial of corticosteroids in predicting the outcome of splenectomy, 36 children with chronic ITP were studied retrospectively. All 20 of the children with a good response to corticosteroids achieved a complete remission after splenectomy, whereas only two of 13 nonresponders exhibited a lasting benefit from surgery. Corticosteroid responsiveness was found to be a highly reliable method of correctly identifying those patients with chronic ITP who would benefit from splenectomy. (Am J Dis Child 1982;136:1064-1066) References 1. Lusher JM, Iyer R: Idiopathic thrombocytopenic purpura in children . Semin Thromb Hemostas 1977;3:175-199. 2. McMillan R: Chronic idiopathic thrombocytopenic purpura . N Engl J Med 1981;304: 1135-1147.Crossref 3. Choi SI, McClure PD: Idiopathic thrombocytopenic purpura in childhood . Can Med Assoc J 1967;97:562-568. 4. Simons SM, Main CA, Yaish HM, et al: Idiopathic thrombocytopenic purpura in children . J Pediatr 1975;87:16-22.Crossref 5. Schulman I: Diagnosis and treatment: Management of idiopathic thrombocytopenic purpura . Pediatrics 1964;33:979-980. 6. Eraklis AJ, Kevy SV, Diamond LK, et al: Hazard of overwhelming infection after splenectomy in childhood . N Engl J Med 1967;276: 1225-1229.Crossref 7. Krivit W: Overwhelming post-splenectomy infection . Am J Hematol 1977;2:193-201.Crossref 8. Philippart AI, Hight DW: Splenectomy in childhood: Altered concepts of management . Am J Pediatr Hematol Oncol 1980;2:61-68. 9. Fleiss JL: Statistical Methods for Rates and Proportions . New York, John Wiley & Sons Inc, 1973, pp 143-147. 10. McMillan R, Longmire RL, Yelenosky R, et al: Immunoglobulin synthesis in vitro by splenic tissue in idiopathic thrombocytopenic purpura . N Engl J Med 1972;286:681-684.Crossref 11. Karpatkin S: Autoimmune thrombocytopenic purpura . Am J Med Sci 1971;261: 127-138.Crossref 12. Baldini M: Idiopathic thrombocytopenic purpura . N Engl J Med 1966;274:1245-1251.Crossref 13. Najean Y, Ardaillou N: The sequestration site of platelets in idiopathic thrombocytopenic purpura: Its correlation with the results of splenectomy . Br J Hematol 1971;21:153-164.Crossref 14. Ries CA, Price DC: (51Cr) Platelet kinetics in thrombocytopenia: Correlation between splenic sequestration of platelets and response to splenectomy . Ann Intern Med 1974;80:702-707.Crossref 15. Barkhan P: Blood and neoplastic diseases: Other purpuras . Br Med J 1974;2:376-378.Crossref 16. Ries CA: Platelet kinetics in autoimmune thrombocytopenia: Relation between splenic platelet sequestration and response to splenectomy . Ann Intern Med 1977;86:194-195.Crossref 17. Richards JDM, Thompson DS: Assessment of thrombocytopenic patients for splenectomy . J Clin Pathol 1979;32:1248-1252.Crossref 18. Lozner EL: The thrombocytopenic purpuras . Bull NY Acad Med 1954;30:184-194. 19. Dixon R, Rosse W, Ebbert L: Quantitative determination of antibody in ITP . N Engl J Med 1975;292:230-236.Crossref 20. Luiken GA, McMillan R, Lightsey AL, et al: Platelet-associated IgG in immune thrombocytopenic purpura . Blood 1977;50:317-325. 21. Cheung N, McFall P, Hilgartner M: Platelet associated IgG and IgM in immune thrombocytopenia , abstracted. Blood 1981;58:190. 22. Harrington W, Arimura G: Immune reactions of platelets , in Johnson SA, Monto RW, Rebuck RW, et al (eds): Henry Ford Symposium: Blood Platelets . Boston, Little Brown & Co, 1961, pp 659-670. 23. Block GE, Evans R, Zajtchuk R: Splenectomy for idiopathic thrombocytopenic purpura . Arch Surg 1966;92:484-489.Crossref 24. Nordoy A, Neset G: Splenectomy in hematologic disease . Acta Med Scand 1968;183:117-126.Crossref 25. Dameshek HL, Ellis LD: Hematologic indications for splenectomy . Surg Clin North Am 1975;55:253-275. 26. Thompson RL, Moore RA, Hess CE, et al: Idiopathic thrombocytopenic purpura: Long-term results of treatment and the prognostic significance of response to corticosteroids . Arch Intern Med 1972;130:730-734.Crossref 27. Brennan MF, Rappeport JM, Moloney WC, et al: Correlation between response to corticosteroids and splenectomy for adult idiopathic thrombocytopenic purpura . Am J Surg 1975;129:490-492.Crossref 28. Walker JH, Walker W: Idiopathic thrombocytopenic purpura in childhood . Arch Dis Child 1961;36:649-657.Crossref 29. Brooks PL, O'Shea MJ, Pryor JP: Splenectomy in the treatment of idiopathic thrombocytopenic purpura . Br J Surg 1969;56:861-863.Crossref 30. Benham ES, Taft LI: Idiopathic thrombocytopenic purpura in children: Results of steroid therapy and splenectomy . Aust Paediatr J 1972;8:311-317. 31. Stuart MJ, McKenna R: Diseases of coagulation: The platelet and vasculature , in Nathan DG, Oski FA (eds): Hematology of Infancy and Childhood , ed 2. Philadelphia, WB Saunders Co, 1981, pp 1234-1256. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Diseases of Children American Medical Association

Steroid Responsiveness: A Predictor of the Outcome of Splenectomy in Children With Chronic Immune Thrombocytopenic Purpura

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References (37)

Publisher
American Medical Association
Copyright
Copyright © 1982 American Medical Association. All Rights Reserved.
ISSN
0002-922X
DOI
10.1001/archpedi.1982.03970480030007
Publisher site
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Abstract

Abstract • Splenectomy is curative for many children with chronic immune thrombocytopenic purpura (ITP), but not without placing them at increased risk for serious infections. To determine the reliability of a trial of corticosteroids in predicting the outcome of splenectomy, 36 children with chronic ITP were studied retrospectively. All 20 of the children with a good response to corticosteroids achieved a complete remission after splenectomy, whereas only two of 13 nonresponders exhibited a lasting benefit from surgery. Corticosteroid responsiveness was found to be a highly reliable method of correctly identifying those patients with chronic ITP who would benefit from splenectomy. (Am J Dis Child 1982;136:1064-1066) References 1. Lusher JM, Iyer R: Idiopathic thrombocytopenic purpura in children . Semin Thromb Hemostas 1977;3:175-199. 2. McMillan R: Chronic idiopathic thrombocytopenic purpura . N Engl J Med 1981;304: 1135-1147.Crossref 3. Choi SI, McClure PD: Idiopathic thrombocytopenic purpura in childhood . Can Med Assoc J 1967;97:562-568. 4. Simons SM, Main CA, Yaish HM, et al: Idiopathic thrombocytopenic purpura in children . J Pediatr 1975;87:16-22.Crossref 5. Schulman I: Diagnosis and treatment: Management of idiopathic thrombocytopenic purpura . Pediatrics 1964;33:979-980. 6. Eraklis AJ, Kevy SV, Diamond LK, et al: Hazard of overwhelming infection after splenectomy in childhood . N Engl J Med 1967;276: 1225-1229.Crossref 7. Krivit W: Overwhelming post-splenectomy infection . Am J Hematol 1977;2:193-201.Crossref 8. Philippart AI, Hight DW: Splenectomy in childhood: Altered concepts of management . Am J Pediatr Hematol Oncol 1980;2:61-68. 9. Fleiss JL: Statistical Methods for Rates and Proportions . New York, John Wiley & Sons Inc, 1973, pp 143-147. 10. McMillan R, Longmire RL, Yelenosky R, et al: Immunoglobulin synthesis in vitro by splenic tissue in idiopathic thrombocytopenic purpura . N Engl J Med 1972;286:681-684.Crossref 11. Karpatkin S: Autoimmune thrombocytopenic purpura . Am J Med Sci 1971;261: 127-138.Crossref 12. Baldini M: Idiopathic thrombocytopenic purpura . N Engl J Med 1966;274:1245-1251.Crossref 13. Najean Y, Ardaillou N: The sequestration site of platelets in idiopathic thrombocytopenic purpura: Its correlation with the results of splenectomy . Br J Hematol 1971;21:153-164.Crossref 14. Ries CA, Price DC: (51Cr) Platelet kinetics in thrombocytopenia: Correlation between splenic sequestration of platelets and response to splenectomy . Ann Intern Med 1974;80:702-707.Crossref 15. Barkhan P: Blood and neoplastic diseases: Other purpuras . Br Med J 1974;2:376-378.Crossref 16. Ries CA: Platelet kinetics in autoimmune thrombocytopenia: Relation between splenic platelet sequestration and response to splenectomy . Ann Intern Med 1977;86:194-195.Crossref 17. Richards JDM, Thompson DS: Assessment of thrombocytopenic patients for splenectomy . J Clin Pathol 1979;32:1248-1252.Crossref 18. Lozner EL: The thrombocytopenic purpuras . Bull NY Acad Med 1954;30:184-194. 19. Dixon R, Rosse W, Ebbert L: Quantitative determination of antibody in ITP . N Engl J Med 1975;292:230-236.Crossref 20. Luiken GA, McMillan R, Lightsey AL, et al: Platelet-associated IgG in immune thrombocytopenic purpura . Blood 1977;50:317-325. 21. Cheung N, McFall P, Hilgartner M: Platelet associated IgG and IgM in immune thrombocytopenia , abstracted. Blood 1981;58:190. 22. Harrington W, Arimura G: Immune reactions of platelets , in Johnson SA, Monto RW, Rebuck RW, et al (eds): Henry Ford Symposium: Blood Platelets . Boston, Little Brown & Co, 1961, pp 659-670. 23. Block GE, Evans R, Zajtchuk R: Splenectomy for idiopathic thrombocytopenic purpura . Arch Surg 1966;92:484-489.Crossref 24. Nordoy A, Neset G: Splenectomy in hematologic disease . Acta Med Scand 1968;183:117-126.Crossref 25. Dameshek HL, Ellis LD: Hematologic indications for splenectomy . Surg Clin North Am 1975;55:253-275. 26. Thompson RL, Moore RA, Hess CE, et al: Idiopathic thrombocytopenic purpura: Long-term results of treatment and the prognostic significance of response to corticosteroids . Arch Intern Med 1972;130:730-734.Crossref 27. Brennan MF, Rappeport JM, Moloney WC, et al: Correlation between response to corticosteroids and splenectomy for adult idiopathic thrombocytopenic purpura . Am J Surg 1975;129:490-492.Crossref 28. Walker JH, Walker W: Idiopathic thrombocytopenic purpura in childhood . Arch Dis Child 1961;36:649-657.Crossref 29. Brooks PL, O'Shea MJ, Pryor JP: Splenectomy in the treatment of idiopathic thrombocytopenic purpura . Br J Surg 1969;56:861-863.Crossref 30. Benham ES, Taft LI: Idiopathic thrombocytopenic purpura in children: Results of steroid therapy and splenectomy . Aust Paediatr J 1972;8:311-317. 31. Stuart MJ, McKenna R: Diseases of coagulation: The platelet and vasculature , in Nathan DG, Oski FA (eds): Hematology of Infancy and Childhood , ed 2. Philadelphia, WB Saunders Co, 1981, pp 1234-1256.

Journal

American Journal of Diseases of Children – American Medical Association

Published: Dec 1, 1982

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