بررسي پاسخ به درمان اسپلنكتومي در بيماران مبتلا به پورپوراي ترومبوسيتوپنيك مزمن ايديوپاتيك در بخش خون بيمارستان حضرت علي اصغر(ص ) طي سالهاي 1378-1357

RESPONSE TO SPLENECTOMY IN CHRONIC ITP: A TWENTY YEARS SURVEY IN HAZRAT ALI ASGHAR HOSPITAL

ITP is an auloimmune disorder, due to increased platelet destruction. This condition may be acute, chronic or recurrent. In the acute form. the platelet count returns to normal within 6 months after diagnosis. in the chronic form, the platelet count remains low beyond 6 months. In approximately 90% of children 1TP is an acute and self-limited disease. Splenectomy is indicated for severe acute 11ʹ1ʹ with life threateninig bleeding. which is nonresponsive to medical treatment. Splenectomy is also indicated in chronic form with bleeding symptoms or persistant platelet count below 30,000/mmʹ, which is nonresponsive to medical treatment for several years. The platelet count usually rises immediately after splenectomy, reaching a maximum 1 to 2 ,weeks postsplenectomy. If the peak of platelet count achived after splenectomy is above 500,0001 mmʹ, permanent remission is likely. In our study we evaluated 21 patients with chronic ITP that were splenectomized. In 18 patients, the duration of postoperation time was over 1 year and in 3 patients it was less than 2 months, so these 3 were not included in our final analysis. We divided the patients in two groups: 1- Group(P): Patients responded to splenectomy (10 patients). rising of platelet count alter splenectomy in 6 patients was greater than 500,0001 mm and persistant at least for 1 year, without any medical therapy > 150.000/ mmʹ. 2- Group (N): Patients who did not respond to splenectomy (8 patients). We tried to find correlation between variables, and respond to splenectomy but because of limited number of patients, we achieved only a significant correlation between postsplenectomy response and patientsʹ age. Patients who had diagnosis of ITP in younger age. had better response to splenectomy later. A correlation between response to IVIg therapy before splenectomy and postsplenectomy was also observed. Because half of the patients of P group had platelet count greater than 500.0001 mmʹ with IVlg therapy, so it is concluded that patients who respond well to IVIg therapy in the primary treatment may show a better respond to splenectomy.