Splenectomy and idiopathic
thrombocytopenic purpura
José Antonio García-Erce, Juan Carlo Vella
Hospital Provincial de Burgos "Divino Valles", Carretera de
Santander s/n, 08.009 Burgos, Spain.
Correspondence: José Antonio Garcia Erce, M.D., Plaza
Ireneo, González, 5, 1°, Santa Cruz de Tenerife,
38.002, Canary Islands. Phone: international+34-922-271564 (or:
+34-670-807552) &endash; E-mail: jgarciae@aehh.org
(or: joseerce@santandersupernet.com
We have recently read the interesting paper about the Italian
splenectomy policies, written by Baccarani et al, which was
published in the May issue of the present volume of
Haematologica.1
It is currently accepted that splenectomy is a second line
treatment in chronic idiopathic thrombocytopenic purpura, when
pharmacological treatments fail or when their duration or toxicity
make then not acceptable. The main haematological indication for
laparoscopic splenectomy in Italy, as in the rest of the world, is
idiopathic thrombocytopenic purpura,1 but authors do
not describe any detail about previous pharmacological treatments,
follow up after splenectomy or postoperative treatment.
As Baccarani et al. report, 59% of splenectomies practised in
Italy are still performed according to classic open technique,
although most of the recent studies have reported that
laparoscopic splenectomy has at least the same incidence of
accessory spleen, response rate, safety and
efficacy;2-4 it also has advantages of small abdominal
trauma, less postoperative pain, better cosmetic results and
faster discharge.2 In addition to that, laparoscopic
splenectomy has not difference in long term results and even
shorten the postoperative stay, saving $233 per patient
treated.3,5
Other question particularly interesting, is the possible positive
value of high-dose intravenous immune globulin administration as a
predictor of the response to splenectomy, with the worst responses
to splenectomy in patients who have poor responses to intravenous
immune globuline,6 and the subsequent important
controversy.7 Young patient age appears to be a
positive predictive factor for both short and long term response
to intravenous immune globulin or to splenectomy, including the
platelet recovery rate and postsplenectomy
thrombocytosis;7,8 on the other hand, a higher peak
platelet count immediately after intravenous immune globulin
administration seems to be correlated with a longer response in
patients with idiopathic thrombocytopenic purpura.9
We agree with Baccarani et al. about the convenience of starting a
wide prospective splenectomy register, but accepting the authors'
invitation to the discussion, we would like to know the Italian
experience in relation to the positive predictive value of
high-dose intravenous immune globulin response as a predictor of
the splenectomy response.
