Predictive factors of response to splenectomy in children with immune thrombocytopenic purpura

Abstract

Background: Immune thrombocytopenic purpura (JTP) is an acquired disorder of unknown cause in which autoantibodies are directed against antigens on the platelet membrane. These platelets are then cleared at an accelerated rate by tissue macrophages in the spleen and other components of the reticuloendothelial system, leading to decreased platelet counts. Medical treatment for ITP includes corticosteroids, intravenous immunoglobulin (JVJG), or intravenous anti-Rho(D) immune globulin (WinRho). Splenectomy is effective in 60% to 90% of children with chronic ITP Up to 30% of children with chronic ITP will continue to have bleeding problems after a splenectomy, and there is the small but present risk of overwhelming postsplenectomy infection, even with the proper immunizations and penicillin prophylaxis. Possible lack of response to and inability to predict response to highlight the need for more potent predictors of response to splenectomy in children with chronic ITP Patients and methods: This study was conducted as a retrospective analysis of all pediatric patients 18 years of age or younger at Menoufia University Hospital with ITP who received medical treatment and eventually required splenectomy between January 2003 and June 2012. Data from files of 24 patients included initial CBC including platelets count and mean platelet volume and initial response to steroid therapy. Also we studied their sex, age, platelet count, years of thrombocytopenia and associated disease. Time of splenectomy and the response to medical therapy were also analyzed to assess their association with splenectomy response. Results: We found that 16 cases (67%) (11 male and 5 female) achieved complete remission while 8 cases (33%)(3 male and 5 female) didn t, but 3 of them achieved partial remission. The mean age at splenectomy of responders and non-responders was 9.906±1.3193 and 11.938±2.4413 respectively, the initial platelets count at diagnosis was 22.4825±11.52027and 22.1813±9.23428 respectively, there were a statistically significant difference when regarding age in years at time of splenectomy (age was higher in non-responders), and platelets count just before splenectomy (higher in non-responders), while other variables did not significantly differ. Conclusion: We concluded that steroid response period is the main predictive factor for response to splenectomy in the study. Also initial MPV, and age in years can be considered as a predictive factor while other variables are not.