Uloga splenektomije u liječenju imunotrombocitopenije

master's thesis

• Title (english): The role of splenectomy in treatment of immune thrombocytopenia
• Author: Karla Benček
• Mentor: Ana Boban (mentor)
• Committee member: Mislav Cerovec (predsjednik povjerenstva)
• Committee member: Jasenka Markeljević (član povjerenstva)
• Committee member: Ana Boban (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2018-07-13, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

ITP je stečena bolest koja se definira brojem trombocita <100 x 109/L u perifernoj krvi i uzrokovana je imunološkom destrukcijom trombocita. Postoji nekoliko linija liječenja ITP-a. U prvoj liniji primjenjuju se glukokortikoidi s ili bez imunoglobulina, a u drugoj splenektomija ili TPO agonisti. Rituksimab i ostali imunosupresivi (azatioprin, mikofenolat-mofetil...) preporučaju se u drugoj ili kasnijim linijama liječenja. Cilj ovog retrospektivnog istraživanja je evaluirati učinak splenektomije kao druge linije liječenja ITP-a u pacijenata koji imaju refraktornu ITP ili su imali relaps. Retrospektivno smo analizirali pacijente s dijagnozom ITP-a praćene u KBC-u Zagreb od 2007. do 2017. godine. Izdvojeno je 55 pacijenata koji su splenektomirani. Pacijenti su podijeljeni u grupe ovisno o odgovoru na splenektomiju pri čemu su postigli potpunu remisiju (CR), parcijalnu remisiju (PR) ili nisu odgovorili na liječenje (NR). Među pacijentima koji su odgovorili na splenektomiju njih 41 (91.1%) bilo je u kompletnoj remisiji, a 4 (8.9%) u parcijalnoj remisiji što je određeno temeljem broja trombocita i znakova krvarenja mjesec dana nakon splenektomije. Bez odgovora bilo je 10 (18.2%) pacijenata. Nakon dugotrajnog praćenja 45 pacijenata koji su inicijalno odgovorili na splenektomiju, u 28 (62.2%) pacijenata održana je remisija, dok je kod njih 17 (37.8%) zabilježen relaps bolesti. Medijan praćenja nakon splenektomije bio je 10 (0.5-43) godina. Splenektomija je vrlo učinkovita metoda liječenja ITP i u drugoj i u trećoj liniji liječenja te se dugotrajna remisija postiže se u velikog broja pacijenata.

Abstract (english)

ITP is an acquired disease defined by a platelet count <100 x 109/L and caused by immune destruction of platelets. ITP can be managed by several lines of treatment. Glucocorticoids with or without intravenous immunoglobulins are recommended as the first line and splenectomy or thrombopoietin receptor agonists as the second line treatment. Rituximab or other immunosuppressive agents are suggested in the second or later treatment lines. The aim of this retrospective study is to evaluate efficacy of splenectomy as the second line treatment in patients with refractory or relapsed ITP. We have retrospectively analysed patients diagnosed with ITP followed at the University Hospital Center Zagreb from 2007 to 2017. We have identified 55 patients that had undergone splenectomy. The response to splenectomy was defined as complete response (CR), partial response (PR) and no response (NR) based on platelet count and signs of bleeding one month after the procedure. Following splenectomy, 41 (91.1%) patients had a complete response and 4 (8.9%) had a partial response. Ten (18.2%) patients did not respond to splenectomy. After the median follow-up of 10 (0.5-43) years, out of 45 (81.8%) patients who initially responded to splenectomy, 28 (62.2%) patients were still in remission and 17 (37.8%) relapsed. Splenectomy is very effective as the second and the third line treatment in patients with ITP and long-term remission is acchieved by numerous patients.

• Keywords: imunotrombocitopenija; refraktorna bolest; relaps; splenektomija
• Keywords (english): immune thrombocytopenia; refractory disease; relapse; splenectomy
• Language: croatian
• URN:NBN: urn:nbn:hr:105:988843
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2019-01-04 10:35:44