Predictive value of response to steroid therapy on response to splenectomy in children with immune thrombocytopenic purpura

• Published in: Surgery Vol. 150; no. 4; pp. 643 - 648
• Main Authors: Hollander, Lindsay L., MD, Leys, Charles M., MD, MSCI, Weil, Brent R., MD, Rescorla, Frederick J., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.10.2011; Elsevier
• Subjects: Adolescent; Biological and medical sciences; Child; Child, Preschool; Female; General aspects; Hematologic and hematopoietic diseases; Humans; Infant; Liver, biliary tract, pancreas, portal circulation, spleen; Male; Medical sciences; Platelet Count; Platelet diseases and coagulopathies; Predictive Value of Tests; Prognosis; Purpura, Thrombocytopenic, Idiopathic - blood; Purpura, Thrombocytopenic, Idiopathic - drug therapy; Purpura, Thrombocytopenic, Idiopathic - surgery; Remission Induction; Retrospective Studies; Splenectomy; Steroids - therapeutic use; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Treatment Outcome; Human; Medicine; Splenectomy; Steroid; Platelet; Treatment; Surgery; Predictive value; Hemopathy; Immune thrombocytopenic purpura; Child
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2011.07.063

Background Many but not all studies suggest that a favorable response to preoperative steroid therapy predicts a successful outcome after splenectomy in children with immune thrombocytopenic purpura (ITP). The purpose of this study is to further examine the relationship between steroid response and outcome after splenectomy in children. Methods After institutional review board approval, records of children undergoing splenectomy for ITP were reviewed. Patients’ responses were determined by platelet counts and grouped by complete response (CR; ≥150,000/μL), partial response (PR; 149,999– ≥50,000/μL), or no response (NR; <50,000/μL). Results Thirty-seven children were identified. After steroid therapy, 20 patients (54%) had CR, 9 (24%) had PR, and 8 (22%) had NR. After splenectomy, 31 patients (84%) had CR, 6 (16%) had PR, and 0 had NR. Of the 20 patients that had a CR to steroid therapy, 18 (80%) had CR and 2 (20%) had PR to splenectomy. Of the 9 patients that had PR to steroids, 7 (78%) had CR to splenectomy and 2 (22%) had PR. Of the 8 patients that had NR to steroids, 6 (75%) had CR and 2 (25%) had PR to splenectomy. Response to splenectomy was not associated with response to steroids ( P = .59). Conclusion These data suggest that response to splenectomy in children with ITP is unrelated to previous response to steroids.