Accessory spleens: preoperative diagnostics limitations and operational strategy in laparoscopic approach to splenectomy in idiopathic thrombocytopenic purpura patients

Idiopalhic thrombocytopenic purpura is an autoimmune disease in which macrophages of reticuloendothelial system, mainly in the spleen, remove platelets covered by autoantibodies from circulation. By removing the spleen 60-80% of patients are cured. Partial remission is achieved in 10-20% cases. Very few patients do not react on splenectomy. Recurrency of idiopathic thrombocytopenic purpura in a splenectomized patient after already achieved complete remission, may be caused by hypertrophy of one or more of the retained accessory spleens. We present 3 patients, 41, 23 and 44 year old, in whom splenectomy for HP had been performed 10, 3 and 11 years earlier. After full remission which lasted 10, 2.5 and 10.5 years a full recurrency of ITP took place with signs of severe thrombocytopenia and haemorrhagic syndrom. Using ultrasonography, computed tomography and scintigraphy accessory spleen/s, were discovered. By their removal, a full remission was achieved in all 3 patients, but full favorable effect appeared approximately three months after surgery during which period additional steroid therapy was necessary.

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The Use of Thorium Dioxide Sol (Thorotrast) in the Roentgenologic Demonstration of Accessory Spleens

Blood ◽

10.1182/blood.v7.9.904.904 ◽

1952 ◽

Vol 7 (9) ◽

pp. 904-914 ◽

Cited By ~ 7

Author(s):

VIRGIL LOEB ◽

WILLIAM B. SEAMAN ◽

CARL V. MOORE

Keyword(s):

Hemolytic Anemia ◽

Idiopathic Thrombocytopenic Purpura ◽

Clinical Management ◽

Hereditary Spherocytosis ◽

Case Reports ◽

Accessory Spleen ◽

Illustrative Case ◽

Thrombocytopenic Purpura ◽

Thorium Dioxide ◽

Accessory Spleens

Abstract Experience with the use of thorium dioxide sol (Thorotrast) in the roentgen demonstration of accessory spleens is described. The importance of the application of this technic to the clinical management of patients with hematologic relapse following splenectomy is emphasized and illustrative case reports are presented. Nine patients were given thorium dioxide in an attempt to demonstrate an accessory spleen. A remission was induced in 1 patient with acquired hemolytic anemia, who had failed to respond to splenectomy, by removal of an accessory spleen demonstrated with thorium dioxide. A second patient with hereditary spherocytosis who relapsed seven years after splenectomy was shown to have an accessory spleen. Seven patients with idiopathic thrombocytopenic purpura who had relapsed following splenectomy were given thorium dioxide and in no case was an accessory spleen found.

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Advances in the diagnosis of idiopathic thrombocytopenic purpura

Seminars in Hematology ◽

10.1053/shem.2000.8956 ◽

2000 ◽

Vol 37 (3) ◽

pp. 249-260 ◽

Cited By ~ 4

Author(s):

Beng H. Chong ◽

Tee Beng Keng

Keyword(s):

Idiopathic Thrombocytopenic Purpura ◽

Thrombocytopenic Purpura

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PAICA: A Method for Characterizing Platelet-Associated Antibodies - Its Application to the Study of Idiopathic Thrombocytopenic Purpura and to the Detection of Platelet-bound c7E3

Thrombosis and Haemostasis ◽

10.1055/s-0038-1650702 ◽

1996 ◽

Vol 76 (06) ◽

pp. 1020-1029 ◽

Cited By ~ 26

Author(s):

Laurent Macchi ◽

Gisèle Clofent-Sanchez ◽

Gérald Marit ◽

Claude Bihour ◽

Catherine Durrieu-Jais ◽

...

Keyword(s):

Monoclonal Antibody ◽

Flow Cytometry ◽

Idiopathic Thrombocytopenic Purpura ◽

Antithrombotic Therapy ◽

Membrane Glycoproteins ◽

Serum Antibodies ◽

Platelet Destruction ◽

Thrombocytopenic Purpura ◽

Capture Assay ◽

Specific Membrane

SummaryIn idiopathic thrombocytopenic purpura (ITP), autoantibodies reacting with antigens on the platelet membrane bring about accelerated platelet destruction. We now report PAICA (“Platelet-Associated IgG Characterization Assay”), a method for detecting autoantibodies bound to specific membrane glycoproteins in total platelet lysates. This monoclonal antibody (MAb) capture assay takes into account the fact that antibodies on circulating platelets may be translocated to internal pools as well as being on the surface. A total of twenty ITP patients were examined by PAICA, and the results compared with those obtained by measuring (i) serum antibodies bound to paraformaldehyde-fixed control platelets by ELISA, (ii) IgG bound to the surface of the patient’s own platelets by flow cytometry (PSIgG), (iii) total platelet-associated IgG (PAIgG) by ELISA and (iv) serum antibodies reacting with control platelets by MAIPA (“Monoclonal Antibody-specific Immobilization of Platelet Antigens”). Of twelve patients with elevated PAIgG, nine had increased PSIgG yet eleven reacted positively in PAICA. Of these, eight possessed antibodies directed against GP Ilb-IIIa, two against GP Ib-IX and one patient possessed antibodies directed against GP Ilb-IIIa and GP Ia-IIa respectively. Only seven of the patients possessed serum antibodies detectable by MAIPA. PAICA was also able to detect platelet-associated c7E3 (the chimeric form of Fab fragments of the MAb 7E3) following its infusion during antithrombotic therapy, when it proved more sensitive over a seven-day period than a MAIPA assay adapted for assessing surface-bound antibody. We propose that PAICA provides added sensitivity to the detection of platelet-associated antibodies in immune thrombocytopenias or following therapy with humanized MAbs.

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