Autologous 111 In-labelled platelet sequestration studies in patients with primary immune thrombocytopenia (ITP) prior to splenectomy: a report from the United Kingdom ITP Registry.
While splenectomy is an effective therapy for primary immune thrombocytopenia (ITP), possible complications and observed non-complete response (CR) in one-third of patients demonstrate the need for further research into potential pre-surgical predictors of outcomes. Past investigations into platelet sequestration studies, a hypothesized predictive test, have adopted heterogeneous methods and varied widely with regard to power. By studying patients with primary ITP who underwent autologous (111) In-labelled platelet sequestration studies at Barts and The London NHS Trust between 1994 and 2008, we evaluated the effectiveness of sequestration site in predicting short, medium, and long-term CR (platelet count >100 × 10(9) /l) to splenectomy through multivariate (gender, age at splenectomy, and mean platelet lifespan) logistic regression modelling. In total, 256 patients with primary ITP underwent scans; 91 (35·5%) proceeded to splenectomy. Logistic regression revealed significant adjusted odds ratios for CR of 7·47 (95% confidence interval [CI], 1·89-29·43) at 1-3 months post-splenectomy, 4·85 (95% CI, 1·04-22·54) at 6-12 months post-splenectomy, and 5·39 (95% CI, 1·34-21·65) at last follow-up (median: 3·8 years [range: 0·5-13·1 years]) in patients with purely or predominantly splenic versus mixed or hepatic sequestration. These findings demonstrate the utility of autologous (111) In-labelled platelet sequestration studies as an adjunct predictive instrument prior to splenectomy.
Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK. avs31@medschl.cam.ac.uk
Ameet
A
Sarpatwari
Drew
D
Provan
Sebhat
S
Erqou
Ravin
R
Sobnack
Foong Way
FW
David Tai
Adrian C
AC
Newland
D000293:Adolescent; D000328:Adult; D000368:Aged; D001792:Blood Platelets / Q000000981:diagnostic imaging / Q000502:physiology*; D016923:Cell Death; D002648:Child; D000075202:Contraindications; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007205:Indium Radioisotopes; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000097:blood* / Q000000981:diagnostic imaging / Q000601:surgery; D011877:Radionuclide Imaging; D013154:Spleen / Q000000981:diagnostic imaging / Q000473:pathology; D013156:Splenectomy; D016896:Treatment Outcome; D055815:Young Adult
D007205:Indium Radioisotopes