Chronic immune thrombocytopenia in children: who needs splenectomy?
Chronic immune thrombocytopenia in children: who needs splenectomy?
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DOI：
10.1053/j.seminhematol.2013.03.010
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发表时间：
2013-01-01
影响因子：
3.6
通讯作者：
Kuhne, Thomas
中科院分区：
文献类型：
--
作者：
Schifferli, Alexandra;Kuhne, Thomas
在新兴的创新疗法领域，如血小板生成素模拟物，谁需要脾切除术的问题仍然高度相关。切除脾脏是免疫性血小板减少症（ITP）的一种公认的潜在治愈性治疗方法，数十年来具有良好的经济效果比，但相关的发病率，特别是在年轻患者中。ITP是罕见的，脾切除术在少数儿童中进行，这使得其研究几乎是不可能的，导致程序标准化差。因此，在儿童中，脾切除术的建议和决定是基于个人的，并取决于专家的意见。此外，当地的做法和保健产品的可用性影响脾切除术的频率。目前的指南同意一点：脾切除术应推迟至少12个月后，ITP的初步诊断，由于改善，甚至自发缓解的可能性很高。然而，基于证据的数据是缺乏和脾切除术仍然存在争议。本文回顾了目前的文献，并阐述了争议和复杂的脾切除术的儿童ITP。目前迫切需要在儿科患者中就该程序达成共识。
In the field of emerging innovative therapies, such as thrombopoietin mimetics, the question of who needs splenectomy remains highly relevant. Removal of the spleen is an accepted and potentially curative treatment of immune thrombocytopenia (ITP) after decades with a favorable economical-effect ratio but with relevant morbidity particularly in the young patients. ITP is rare and splenectomy is performed in a minority of children, which makes its research almost impossible, resulting in a poor standardization of the procedure. Hence, in children, recommendation and decision for splenectomy is individually based and rests on expert opinions. Furthermore, local practice and availability of health products affect the frequency of splenectomy. Current guidelines agree on one point: splenectomy should be postponed for at least 12 months after the initial diagnosis of ITP, due to the high probability of improvement or even spontaneous remission. However, evidence-based data are lacking and splenectomy remains controversial. This article reviews the current literature and delineates controversies and complexities of splenectomy in children with ITP. There is an urgent need for consensus of this procedure in pediatric patients.