The response to splenectomy in pediatric patients with idiopathic thrombocytopenic purpura who fail high-dose intravenous immune globulin

• Published in: Journal of pediatric surgery 2000-06, Vol.35 (6), p.967-972
• Main Authors: Hemmila, Mark R., Foley, David S., Castle, Valerie P., Hirschl, Ronald B.
• Format: Article
• Language: English
• Subjects: Adolescent; Child; Child, Preschool; Female; Humans; Idiopathic thrombocytopenic purpura; immune globulin; Immunoglobulins, Intravenous - administration & dosage; Male; Platelet Count; Purpura, Thrombocytopenic, Idiopathic - blood; Purpura, Thrombocytopenic, Idiopathic - surgery; Purpura, Thrombocytopenic, Idiopathic - therapy; Retrospective Studies; Splenectomy; Treatment Failure
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1053/jpsu.2000.6938

Background/Purpose: A recent article by Law et al concluded that patients with idiopathic thrombocytopenic purpura (ITP) who have a poor response to intravenous immune globulin (IgG) are unlikely to have a good or excellent response to surgical splenectomy. Methods: The authors studied retrospectively 23 pediatric patients age 11.7 ± 1.0 years with ITP who had been treated with IgG before undergoing splenectomy. As in the aforementioned article, the responses to the 2 treatments were classified on the basis of the platelet count as poor (150,000/mm3). For patients who received multiple IgG treatments, both initial and final treatment responses were analyzed. Results: Sixteen patients had an excellent or good initial response to IgG. Of these 16 patients, 14 had an excellent or good response to splenectomy. Among the 7 patients who had a poor response to IgG there were 3 who had an excellent or good response to splenectomy (43%), and 4 patients who had a poor response to splenectomy. A good or excellent response to initial treatment with IgG was associated with a significant probability of a good or excellent response to splenectomy (P =.045). Conclusions: A good or excellent response to IgG may be predictive of a favorable response to splenectomy. However, a poor response to IgG does not preclude a satisfactory response to splenectomy in pediatric patients with ITP. J Pediatr Surg 35:967-972. Copyright © 2000 by W.B. Saunders Company.