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Platelet survival and turnover: Important factors in predicting response to splenectomy in immune thrombocytopenic purpura
Author(s) -
Siegel Robert S.,
Rae Janice L.,
Barth Susan,
Coleman R. Edward,
Reba Richard C.,
Kurlander Roger,
Rosse Wendell F.
Publication year - 1989
Publication title -
american journal of hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.456
H-Index - 105
eISSN - 1096-8652
pISSN - 0361-8609
DOI - 10.1002/ajh.2830300404
Subject(s) - splenectomy , platelet , medicine , thrombocytopenic purpura , gastroenterology , immunology , immune system , mean platelet volume , spleen
Autologous indium‐111 platelet sequestration and survival studies were performed on 59 immune thrombocytopenic purpura (ITP) patients, 21 of whom underwent splenectomy shortly thereafter. Sequestration patterns were primarily splenic in 46 patients, primarily hepatic in 6 patients, and both splenic and hepatic in 8 patients. The mean platelet survival ranged from 15 to 211 hr (normal, 180‐220 hr), and mean platelet turnover (a measure of platelet production rate) varied from 99 platelets/μl/hr to 7,585 platelets/μl/hr (normal 1,200‐1,600 platelets/μl/hr). Among splenectomy patients, 13 had an excellent response, and 8 had a fair or poor response. Neither the pattern of platelet sequestration nor the quantity of platelet‐associated IgG was useful in predicting response to splenectomy. There was, however, a striking correlation between platelet studies showing short survival/high turnover and subsequent excellent responses to splenectomy. Conversely, patients with only moderately decreased survival and low turnover had an unpredictable response to splenectomy. This investigation demonstrates that ITP patients are a heterogeneous population and include a significant subset whose thrombocytopenia results primarily from decreased turnover. Platelet kinetic studies appear useful in predicting beneficial response to splenectomy.