OBJECTIVE: To determine the effectiveness and safety of splenectomy for patients with human immunodeficiency virus (HIV)-related immune thrombocytopenia, using the results of splenectomy for patients with non-HIV immune thrombocytopenic purpura as a control group for comparison. DESIGN: Retrospective study. SETTING: Tertiary care university hospital. PATIENTS: Fourteen patients who underwent splenectomy for symptomatic, medically refractory HIV-related immune thrombocytopenia at this hospital from 1988 to 1997. During the same period, 20 patients had splenectomy for treatment of non-HIV immune thrombocytopenic purpura. INTERVENTION: Splenectomy. MAIN OUTCOME MEASURES: Platelet response, need for postsplenectomy medical therapy, progression of HIV disease, and complications. RESULTS: All patients with HIV-related thrombocytopenia had a complete early platelet response to splenectomy, with an elevation of the platelet count to greater than 100X10(9)/L. After a median follow-up of 26.5 months, all but 1 patient had a sustained complete remission with no need for medical therapy for thrombocytopenia. Splenectomy was more effective in the HIV-related thrombocytopenia group than in the non-HIV immune thrombocytopenic purpura group, with significantly higher platelet counts at 1 week and 1 month after splenectomy in the HIV group (t test, P=.02 and P=.009, respectively). There were significantly fewer patients needing medical therapy for thrombocytopenia after splenectomy in the HIV group (chi2 test, P=.02). There were no remarkable short- or long-term complications in the patients with HIV infection, including no overwhelming postsplenectomy infections. Three patients have died, and 2 patients have developed AIDS since operation. CONCLUSIONS: Splenectomy is effective treatment for patients with symptomatic HIV-related thrombocytopenia that is resistant to medical therapy. The effectiveness of this treatment suggests that the predominant mechanism of thrombocytopenia in HIV-infected patients is increased destruction of platelets because of platelet-associated immunoproteins.
OBJECTIVE: To determine the effectiveness and safety of splenectomy for patients with human immunodeficiency virus (HIV)-related immune thrombocytopenia, using the results of splenectomy for patients with non-HIV immune thrombocytopenic purpura as a control group for comparison. DESIGN: Retrospective study. SETTING: Tertiary care university hospital. PATIENTS: Fourteen patients who underwent splenectomy for symptomatic, medically refractory HIV-related immune thrombocytopenia at this hospital from 1988 to 1997. During the same period, 20 patients had splenectomy for treatment of non-HIV immune thrombocytopenic purpura. INTERVENTION: Splenectomy. MAIN OUTCOME MEASURES: Platelet response, need for postsplenectomy medical therapy, progression of HIV disease, and complications. RESULTS: All patients with HIV-related thrombocytopenia had a complete early platelet response to splenectomy, with an elevation of the platelet count to greater than 100X10(9)/L. After a median follow-up of 26.5 months, all but 1 patient had a sustained complete remission with no need for medical therapy for thrombocytopenia. Splenectomy was more effective in the HIV-related thrombocytopenia group than in the non-HIV immune thrombocytopenic purpura group, with significantly higher platelet counts at 1 week and 1 month after splenectomy in the HIV group (t test, P=.02 and P=.009, respectively). There were significantly fewer patients needing medical therapy for thrombocytopenia after splenectomy in the HIV group (chi2 test, P=.02). There were no remarkable short- or long-term complications in the patients with HIV infection, including no overwhelming postsplenectomy infections. Three patients have died, and 2 patients have developed AIDS since operation. CONCLUSIONS: Splenectomy is effective treatment for patients with symptomatic HIV-related thrombocytopenia that is resistant to medical therapy. The effectiveness of this treatment suggests that the predominant mechanism of thrombocytopenia in HIV-infectedpatients is increased destruction of platelets because of platelet-associated immunoproteins.
Authors: Matthew C Hernandez; Michael D Traynor; Ariel W Knight; Victor Y Kong; Grant L Laing; John L Bruce; Wanda Bekker; Martin D Zielinski; Damian L Clarke Journal: World J Surg Date: 2020-05 Impact factor: 3.352
Authors: C Balagué; S Vela; E M Targarona; I J Gich; E Muñiz; A D'Ambra; A Pey; V Monllau; E Ascaso; C Martinez; J Garriga; M Trias Journal: Surg Endosc Date: 2006-07-24 Impact factor: 4.584
Authors: C Balagué; E M Targarona; G Cerdán; J Novell; O Montero; G Bendahan; A García; A Pey; S Vela; M Diaz; M Trías Journal: Surg Endosc Date: 2004-06-23 Impact factor: 4.584