FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 336:1494-1498 May 22, 1997 Number 21 Next

	Full Text PDF Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background High-dose intravenous immune globulin produces a temporary rise in the platelet count in patients with idiopathic thrombocytopenic purpura. Splenectomy may also be effective, but it is not possible to predict which patients will have a good response. We hypothesized that the response to intravenous immune globulin predicts the response to splenectomy.

Methods We studied retrospectively 30 patients with idiopathic thrombocytopenic purpura who had first been treated with immune globulin and then undergone splenectomy. The responses to the two treatments were classified on the basis of the platelet count as poor (<50,000 per cubic millimeter), good (50,000 to 150,000 per cubic millimeter), or excellent (>150,000 per cubic millimeter).

Results All nine patients who had poor responses to intravenous immune globulin also had poor responses to splenectomy at one year. Of the 21 patients with good or excellent responses to intravenous immune globulin, 19 had good or excellent responses to splenectomy.

Conclusions Patients with idiopathic thrombocytopenic purpura who have good or excellent responses to intravenous immune globulin are likely to have good or excellent responses to splenectomy, whereas patients who have poor responses to intravenous immune globulin are unlikely to have good or excellent responses to splenectomy.

Source Information

From the Departments of Surgery (C.L., M.M., P.T.), Pathology (N.H., J.G.K.), and Medicine (J.G.K.), McMaster University and the Hamilton Health Sciences Corporation, Hamilton, Ont., Canada.

Address reprint requests to Dr. Kelton at Rm. 3W10, McMaster University Medical Centre, 1200 Main St. W., Hamilton, ON L8N 3Z5, Canada.

Full Text of this Article

Related Letters:

High-Dose Intravenous Immune Globulin and the Response to Splenectomy in Patients with Idiopathic Thrombocytopenic Purpura
Schneider P., Wehmeier A., Schneider W., Fabris F., Cordiano I., Girolami A., Kelton J. G., Law C., Heddle N.
Extract | Full Text  
N Engl J Med 1997; 337:1087-1089, Oct 9, 1997. Correspondence

This article has been cited by other articles:

• Ruggeri, M., Fortuna, S., Rodeghiero, F. (2008). Heterogeneity of terminology and clinical definitions in adult idiopathic thrombocytopenic purpura: a critical appraisal from a systematic review of the literature. haematol 93: 98-103 [Abstract] [Full Text]  
• Go, R. S., Johnston, K. L., Bruden, K. C. (2007). The association between platelet autoantibody specificity and response to intravenous immunoglobulin G in the treatment of patients with immune thrombocytopenia. haematol 92: 283-284 [Abstract] [Full Text]  
• Kojouri, K., Vesely, S. K., Terrell, D. R., George, J. N. (2004). Splenectomy for adult patients with idiopathic thrombocytopenic purpura: a systematic review to assess long-term platelet count responses, prediction of response, and surgical complications. Blood 104: 2623-2634 [Abstract] [Full Text]  
• Watts, R. G. (2004). Idiopathic Thrombocytopenic Purpura: A 10-Year Natural History Study at the Childrens Hospital of Alabama. CLIN PEDIATR 43: 691-702 [Abstract]  
• Kuwana, M., Nomura, S., Fujimura, K., Nagasawa, T., Muto, Y., Kurata, Y., Tanaka, S., Ikeda, Y. (2004). Effect of a single injection of humanized anti-CD154 monoclonal antibody on the platelet-specific autoimmune response in patients with immune thrombocytopenic purpura. Blood 103: 1229-1236 [Abstract] [Full Text]  
• Duperier, T., Brody, F., Felsher, J., Walsh, R. M., Rosen, M., Ponsky, J. (2004). Predictive Factors for Successful Laparoscopic Splenectomy in Patients With Immune Thrombocytopenic Purpura. Arch Surg 139: 61-66 [Abstract] [Full Text]  
• Webert, K. E., Mittal, R., Sigouin, C., Heddle, N. M., Kelton, J. G. (2003). A retrospective 11-year analysis of obstetric patients with idiopathic thrombocytopenic purpura. Blood 102: 4306-4311 [Abstract] [Full Text]  
• Holt, D., Brown, J., Terrill, K., Goldsby, R., Meyers, R. L., Heximer, J., Nordfors, B., Slayton, W. B. (2003). Response to Intravenous Immunoglobulin Predicts Splenectomy Response in Children With Immune Thrombocytopenic Purpura. Pediatrics 111: 87-90 [Abstract] [Full Text]  
• Kuwana, M., Okazaki, Y., Kaburaki, J., Kawakami, Y., Ikeda, Y. (2002). Spleen Is a Primary Site for Activation of Platelet-Reactive T and B Cells in Patients with Immune Thrombocytopenic Purpura. J. Immunol. 168: 3675-3682 [Abstract] [Full Text]  
• Chu, Y.-W., Korb, J., Sakamoto, K. M. (2000). Idiopathic Thrombocytopenic Purpura. Pediatr. Rev. 21: 95-104 [Full Text]  
• Yokoyama, H., Goshima, S., Wada, T., Takaeda, M., Furuichi, K., Kobayashi, K.-i., Kida, H., the Kanazawa Study Group for Renal Diseases and Hy, (1999). The short- and long-term outcomes of membranous nephropathy treated with intravenous immune globulin therapy. Nephrol Dial Transplant 14: 2379-2386 [Abstract] [Full Text]  
• Galindo, M., Khamashta, M. A., Hughes, G. R. V. (1999). Splenectomy for refractory thrombocytopenia in the antiphospholipid syndrome. Rheumatology (Oxford) 38: 848-853 [Abstract] [Full Text]  
• McKenzie, S. E., Taylor, S. M., Malladi, P., Yuhan, H., Cassel, D. L., Chien, P., Schwartz, E., Schreiber, A. D., Surrey, S., Reilly, M. P. (1999). The Role of the Human Fc Receptor Fc{gamma}RIIA in the Immune Clearance of Platelets: A Transgenic Mouse Model. J. Immunol. 162: 4311-4318 [Abstract] [Full Text]  
• Schneider, P., Wehmeier, A., Schneider, W., Fabris, F., Cordiano, I., Girolami, A., Kelton, J. G., Law, C., Heddle, N. (1997). High-Dose Intravenous Immune Globulin and the Response to Splenectomy in Patients with Idiopathic Thrombocytopenic Purpura. NEJM 337: 1087-1089 [Full Text]  
• (1997). PREDICTING THE RESPONSE TO SPLENECTOMY IN ITP. JWatch General 1997: 4-4 [Full Text]