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Histology of the spleen in immune thrombocytopenia: clinical‐pathological characterization and prognostic implications
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 splenectom...
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Published in: | European journal of haematology 2021-02, Vol.106 (2), p.281-289 |
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Main Authors: | , , , , , , , , , , , , , , , , , , , , , |
Format: | Article |
Language: | English |
Subjects: | |
Citations: | Items that this one cites Items that cite this one |
Online Access: | Get full text |
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Summary: | 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. |
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ISSN: | 0902-4441 1600-0609 |
DOI: | 10.1111/ejh.13547 |