RESUMO
OBJECTIVE: To study the outcome of patients with idiopathic thrombocytopenic purpura (ITP) treated with splenectomy, with respect to the development of systemic lupus erythematosus (SLE). METHODS: Two independent observers reviewed data of 20 clinical, laboratory, and therapeutic variables of patients with ITP, with no clinical or laboratory indications of SLE, who were treated by splenectomy from 1952 to August 1995. 115 patients were studied, 86 female, 25 male, mean age 31.5 (SD 15.4) yrs (range 10-75), who had a mean followup of 7.2 (SD 7.5) yrs (range 0.08-32.8). RESULTS: 14 patients (12.1%) developed SLE. The most common SLE manifestations were arthritis (78.5%), lymphopenia (74.1%), mucocutaneous manifestations (64.2%), and hemolytic anemia (35.7%). Mortality was greater in the SLE group than in the ITP group (3 vs 4; odds ratio 6.61, 95% confidence interval 1.57-27.76, p = 0.037). 67% of the patients with ITP and 57.2% with SLE were in complete remission at the last visit (p = 0.54). CONCLUSION: Almost one of 8 patients with splenectomy due to ITP developed SLE. These patients require periodic followup to monitor other clinical data of SLE.
Assuntos
Lúpus Eritematoso Sistêmico/complicações , Púrpura Trombocitopênica/etiologia , Adolescente , Adulto , Idoso , Criança , Feminino , Seguimentos , Humanos , Incidência , Lúpus Eritematoso Sistêmico/mortalidade , Lúpus Eritematoso Sistêmico/cirurgia , Masculino , Pessoa de Meia-Idade , Púrpura Trombocitopênica/mortalidade , Púrpura Trombocitopênica/cirurgia , Esplenectomia , Resultado do TratamentoRESUMO
Between January 1976 and December 1987, 44 patients with idiopathic thrombocytopenic purpura were submitted to splenectomy. This study analyzes the results of treatment and the usefulness of several prognostic markers. There were 38 female patients and six males with a median age of 28.5 years (range 11 to 66 years). Forty two out of 44 patients received preoperative steroids. Seventy five percent achieved a satisfactory response to this treatment but 31 relapsed (in eight recurrence was observed when the steroid dose was tapered). Eleven patients persisted symptomatic notwithstanding medical treatment. In two cases splenectomy was performed as an emergency procedure, and in one patient who was already in remission with previous steroid treatment, splenectomy was performed for other medical reasons. Operative mortality rate was 4 percent, and five patients developed postoperative complications (three had pneumonia, one pulmonary thromboembolism and one would infection). Eighty four percent of the patients were free of disease at one year followup survival at 10 year period was 80 percent. No correlation was found between age, duration of symptoms, previous response to steroids or time-period of medical treatment with the results obtained with splenectomy.
Assuntos
Púrpura Trombocitopênica/cirurgia , Esplenectomia , Adolescente , Adulto , Idoso , Criança , Terapia Combinada , Estudos de Avaliação como Assunto , Feminino , Humanos , Tábuas de Vida , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Prednisona/uso terapêutico , Púrpura Trombocitopênica/tratamento farmacológico , Púrpura Trombocitopênica/mortalidade , Recidiva , Esplenectomia/efeitos adversos , Taxa de SobrevidaRESUMO
Se revisaron todas las historias con diagnostico de prupura trombocitopenica idiopatica (PTI), de los pacientes que ingresaron al hospital San Juan de Dios de la ciudad de Bogota, durante el periodo comprendido entre el 1 de enero de 1980 y el 31 de diciembre de 1985; con el fin de identificar la forma de presentacion, incidencia, factores pronosticos y respuesta al tratamiento. Se encontraron 54 historias con diagnostico de PTI de las cuales 32 reunian los criterios establecidos para ser5 incluidas en el trabajo; 22 (68%) eran mujeres y 10 (31.5%) hombres. La edad promedio en las mujeres fue de 26.2 anos y de 27.7 para los hombres. Se encontraron antecedentes importantes en 11 pacientes. Los motivos de consulta mas comunes fueron: petequias 100%, equimosis 68.7%, gingivorragia 50% y epistaxis 53.1%. De los 32 pacientes hospitalizados, 4 (12.5%) mejoraron espontaneamente, 17 (60.7%) mejoraron al tratamiento con prednisona, 11 (39.3%) no respondieron a dicho tratamiento. a 7 de estos pacientes se les practico esplenectomia, 5 de los cuales habia recibido prednisona y azatioprina y 2 solamente prednisona. Todos mejoraron. Con base en estas observaciones se propone la realizacion de un estudio prospectivo en nuestro hospital, utilizando como modalidades terapeuticas: 1) corticoterapia, si no hay remision o se presentan exacerbaciones por mas de 6 meses estaria indicada la esplenectomia y por ultimo el uso de inmunosupresores en quienes sean refractarios a las 2 modalidades terapeuticas anteriores