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Histology of the spleen in immune thrombocytopenia: clinical‐pathological characterization and prognostic implications
Author(s) -
Pizzi Marco,
Friziero Alberto,
Vianello Fabrizio,
Binotto Gianni,
Da Dalt Gianfranco,
Zoletto Simone,
Carraro Elisa,
Fassan Matteo,
Sbaraglia Marta,
Sperti Cosimo,
Baldan Nicola,
D’Amore Fabio,
Bertozzi Irene,
Righi Simona,
Pierobon Elisa Sefora,
Moletta Lucia,
Capovilla Giovanni,
Grego Andrea,
Sabattini Elena,
Fabris Fabrizio,
Merigliano Stefano,
Dei Tos Angelo Paolo
Publication year - 2021
Publication title -
european journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 84
eISSN - 1600-0609
pISSN - 0902-4441
DOI - 10.1111/ejh.13547
Subject(s) - splenectomy , white pulp , red pulp , spleen , germinal center , histology , medicine , marginal zone , immune system , pathology , immune thrombocytopenia , platelet , pathological , immunology , gastroenterology , b cell , antibody
Objective Immune thrombocytopenia (ITP) is an acquired disorder, characterized by immune‐mediated platelet destruction. The spleen plays a key pathogenic role in ITP and splenectomy is a valuable second‐line therapy for this disease. Little is known on ITP spleen histology and response to splenectomy is unpredictable. This study aims to characterize ITP spleen histology and assess possible predictors of splenectomy outcome. Methods A series of 23 ITP spleens were retrospectively assessed for the following histological parameters: density of lymphoid follicles (LFs), marginal zones (MZs), T helper and cytotoxic T cells; presence of reactive germinal centers (GCs); width of perivascular T cell sheaths; and red pulp features. Clinical and histological data were matched with postsplenectomy platelet counts to assess their prognostic relevance. Results Three histological patterns were documented: a hyperplastic white pulp pattern, a non‐activated white pulp pattern (lacking GCs), and a white pulp‐depleted pattern. Poor surgical responses were associated with presplenectomy high‐dose steroid administration, autoimmune comorbidities and low T follicular helper cell density. The combination of such parameters stratified patients into different splenectomy response groups. The removal of accessory spleens was also associated with better outcome. Conclusion ITP spleens are histologically heterogeneous and clinical‐pathological parameters may help predict the splenectomy outcome.