title: The scintigraphic index spleen/liver at 30 minutes predicts the success of splenectomy in persistent and chronic primary immune thrombocytopenia.
abstract: Splenectomy is considered the second-line of treatment in patients with chronic primary immune thrombocytopenia (ITP) in whom glucocorticoids have failed. Some patients do not respond to splenectomy or they have postoperative complications. Based on our previous experience using kinetic and scintigraphic parameters, we did a retrospective study with the aim of comparing all these parameters as a means of predicting the success of splenectomy in persistent and chronic primary ITP. Forty-one consecutive patients with chronic primary ITP refractory to prednisone, who had been splenectomized, were included in the study. The response to splenectomy was assessed by evaluating bleeding and platelet counts before and at different times after surgery. A complete platelet kinetic study was performed before the splenectomy using autologous (111) In-labeled platelets. The scintigraphic parameters measured included different indices between spleen/heart, liver/hearth, and spleen/liver. Thirty-six patients gave a complete response after splenectomy and five patients did not respond. A statistically significant difference between both groups was found with initial platelet recovery and with some scintigraphic indices which also showed a variable prediction value for the success of splenectomy. Among these indices, the spleen/liver at 30 minutes demonstrated a predictive value with a 100% of sensitivity and a 100% of specificity.
  
  
  CONCLUSIONS
  some platelet kinetic parameters and scintigraphic indices, in particular the spleen/liver at 30 minutes, were useful to predict the outcome of splenectomy in persistent and chronic primary ITP and, therefore, they should be taken into account when deciding whether or not to perform a splenectomy.
authors.affiliation: Department of Nuclear Medicine, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain.
authors.forename: Manel
authors.initials: M
authors.lastname: Roca
authors.forename: Eduardo
authors.initials: E
authors.lastname: Muñiz-Diaz
authors.forename: Jaume
authors.initials: J
authors.lastname: Mora
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Romero-Zayas
authors.forename: Olga
authors.initials: O
authors.lastname: Ramón
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Roig
authors.forename: Núria
authors.initials: N
authors.lastname: Pujol-Moix
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001792:Blood Platelets / Q000000981:diagnostic imaging* / Q000502:physiology; D002908:Chronic Disease; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging; D006470:Hemorrhage / Q000517:prevention & control; D006801:Humans; D007205:Indium Radioisotopes; D008099:Liver / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011237:Predictive Value of Tests; D011241:Prednisone / Q000008:administration & dosage; D011379:Prognosis; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013154:Spleen / Q000000981:diagnostic imaging / Q000601:surgery; D013156:Splenectomy; D013921:Thrombocytopenia / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000276:immunology / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D007205:Indium Radioisotopes; D011241:Prednisone