Splenectomy. The treatment of choice for human immunodeficiency virus-related immune thrombocytopenia?
Immune thrombocytopenia is a well-recognized part of the clinical spectrum of infection with the human immunodeficiency virus. From November 1985 to February 1988, 15 patients who were human immunodeficiency virus-positive underwent splenectomy for refractory immune thrombocytopenia. Eight patients had thrombocytopenia only, and 7 others were pancytopenic prior to splenectomy. Three of the 15 patients fulfilled criteria for acquired immunodeficiency syndrome before splenectomy, and acquired immunodeficiency syndrome developed in 5 patients during the follow-up period. The median duration of thrombocytopenia prior to surgical therapy was 6 months. A bone marrow biopsy specimen showed hypercellularity with increased megakaryocytes. All patients had a therapeutic response to splenectomy. Long-term remission from thrombocytopenia/pancytopenia was achieved in 14 of the 15 patients during a follow-up period of 2 to 21 months. Splenectomy can be accomplished with an acceptable morbidity. Pneumonia developed postoperatively in 2 patients, but they did not manifest the characteristic picture of overwhelming postsplenectomy sepsis. They had received vaccinations against encapsulated organisms preoperatively. We conclude that splenectomy provides a durable and lasting response for HIV-related thrombocytopenia. Vaccination for Streptococcus pneumonia and Haemophilus influenzae should be given prior to splenectomy although its efficacy is not clear in this group.
Ravikumar
T S
TS
Department of Surgery, New England Deaconess Hospital, Harvard Medical School, Boston, Mass. 02215.
Allen
J D
JD
Bothe
A
A
Steele
G
G
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000328:Adult; D001428:Bacterial Vaccines; D004760:Enterocolitis / Q000209:etiology; D005260:Female; D005334:Fever / Q000209:etiology; D006192:Haemophilus Infections / Q000517:prevention & control; D006193:Haemophilus influenzae / Q000276:immunology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011008:Pneumococcal Infections / Q000517:prevention & control; D011018:Pneumonia, Pneumococcal / Q000209:etiology; D011300:Preoperative Care; D012074:Remission Induction; D013154:Spleen / Q000473:pathology; D013156:Splenectomy / Q000009:adverse effects; D013530:Surgical Wound Infection / Q000209:etiology; D013921:Thrombocytopenia / Q000209:etiology / Q000601:surgery*
D001428:Bacterial Vaccines