Clinical aspects of idiopathic thrombocytopenic purpura in Japan and evaluation of immunoglobulin therapy.
In 1973 the Ministry of Welfare placed ITP on its list of designated diseases and sponsored group research into the disease, particularly the chronic type, which mainly affects adult females, and which presents the greater problem in treatment. With the cooperation of this group, I have surveyed the present situation concerning ITP in Japan. ITP is considered to arise through an autoimmune mechanism, and while conventional tests for antiplatelet antibodies have shown little diagnostic value, recently developed methods for measuring platelet-associated IgG (PAIgG) and platelet-binding IgG (PBIgG) in the serum have proved diagnostically useful. A nationwide survey conducted in 1977 showed that of 1,669 cases of chronic ITP, 399 were treated by splenectomy and full recovery was secured in 200 (50.1%) of them, while of the remaining 1,270 conservatively treated cases only 286 (22.5%) showed full recovery. This clearly demonstrates the value of splenectomy in treating chronic ITP and argues for wider application of this operation. Moreover, in some patients who fail to achieve full recovery after splenectomy alone, combined adrenocorticosteroid and immunosuppressant therapy has been shown to promote recovery. A further method of treatment that has recently appeared is high-dose immunoglobulin therapy. A nationwide cooperative study has shown that this method can be effective in patients who are unresponsive to splenectomy and adrenocorticosteroids.
Yasunaga
K
K
Department of Medicine, Kansai Medical University, Osaka, Japan.
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D001323:Autoantibodies / Q000032:analysis; D001327:Autoimmune Diseases / Q000473:pathology* / Q000628:therapy; D001792:Blood Platelets / Q000276:immunology; D002648:Child; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007116:Immunization, Passive; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011696:Purpura, Thrombocytopenic / Q000276:immunology / Q000473:pathology* / Q000628:therapy; D013156:Splenectomy
D000305:Adrenal Cortex Hormones; D001323:Autoantibodies; D007166:Immunosuppressive Agents