PURPOSE: To determine the value in diagnosis and treatment of mean platelet life, platelet production, and major sites of platelet destruction in patients with idiopathic thrombocytopenic purpura (ITP). PATIENTS AND METHODS: Sternal or posterior superior iliac spine bone marrow aspiration was performed in 141 patients. Platelet kinetic studies with Indium-111 tropolonate labeled autologous platelets were utilized to determine platelet production. RESULTS: Two subgroups of patients could be defined. The first group (n = 81, 58%) had normal or increased platelet production and increased peripheral platelet destruction. These patients fulfilled the conventional criteria for ITP, including reduced platelet survival time (mean +/- SD, 1.6 +/- 1.4 days). Forty-eight (59%) of these patients had increased splenic sequestration and 30 (88%) of the 34 patients who underwent splenectomy had a complete or partial remission. The second group (n = 60, 42%) had decreased platelet production, with significantly greater platelet survival times (3.6 +/- 2 days, P <0.0001). In this group, the proportion of patients with complete or partial response to splenectomy (62%) was somewhat lower (P = 0.09). These patients mainly had ineffective platelet production in the bone marrow. CONCLUSIONS: Platelet kinetic studies suggest that ITP is a heterogeneous disease that comprises two subgroups. Further studies are needed to validate these findings and to determine their effect on the choice and outcome of therapy.
PURPOSE: To determine the value in diagnosis and treatment of mean platelet life, platelet production, and major sites of platelet destruction in patients with idiopathic thrombocytopenic purpura (ITP). PATIENTS AND METHODS: Sternal or posterior superior iliac spine bone marrow aspiration was performed in 141 patients. Platelet kinetic studies with Indium-111 tropolonate labeled autologous platelets were utilized to determine platelet production. RESULTS: Two subgroups of patients could be defined. The first group (n = 81, 58%) had normal or increased platelet production and increased peripheral platelet destruction. These patients fulfilled the conventional criteria for ITP, including reduced platelet survival time (mean +/- SD, 1.6 +/- 1.4 days). Forty-eight (59%) of these patients had increased splenic sequestration and 30 (88%) of the 34 patients who underwent splenectomy had a complete or partial remission. The second group (n = 60, 42%) had decreased platelet production, with significantly greater platelet survival times (3.6 +/- 2 days, P <0.0001). In this group, the proportion of patients with complete or partial response to splenectomy (62%) was somewhat lower (P = 0.09). These patients mainly had ineffective platelet production in the bone marrow. CONCLUSIONS: Platelet kinetic studies suggest that ITP is a heterogeneous disease that comprises two subgroups. Further studies are needed to validate these findings and to determine their effect on the choice and outcome of therapy.
Authors: Vishwanath K Mahabir; Catherine Ross; Snezana Popovic; Mona Lisa Sur; Jacqueline Bourgeois; Wendy Lim; James N George; Grace Wang; Richard J Cook; Lisa J Toltl; Ishac Nazi; John G Kelton; Donald M Arnold Journal: Eur J Haematol Date: 2012-12-13 Impact factor: 2.997
Authors: Silvia Park; Sung Soo Yoon; Jung Hee Lee; Joon Seong Park; Jun Ho Jang; Jong Wook Lee Journal: Int J Hematol Date: 2015-10-28 Impact factor: 2.490
Authors: Ingrid Pabinger; Günther Gastl; Michael Steurer; Siegfried Sormann; Michael Fillitz; Josef Friedl; Dietmar Geissler; Klaus Geissler; Richard Greil; Paul Knöbl; Sibylle Kozek-Langenecker; Peter Krippl; Paul Kyrle; Alois Lang; Werner Linkesch; Heinz Ludwig; Markus Müller; Simon Panzer; Elisabeth Pittermann; Josef Thaler; Ansgar Weltermann Journal: Wien Klin Wochenschr Date: 2012-03-03 Impact factor: 1.704
Authors: Donald M Arnold; Ishac Nazi; Lisa J Toltl; Catherine Ross; Nikola Ivetic; James W Smith; Yang Liu; John G Kelton Journal: Eur J Haematol Date: 2015-03-13 Impact factor: 2.997