Ravikumar T S, Allen J D, Bothe A, Steele G
Department of Surgery, New England Deaconess Hospital, Harvard Medical School, Boston, Mass. 02215.
Arch Surg. 1989 May;124(5):625-8. doi: 10.1001/archsurg.1989.01410050115022.
Immune thrombocytopenia is a well-recognized part of the clinical spectrum of infection with the human immunodeficiency virus. From November 1985 to February 1988, 15 patients who were human immunodeficiency virus-positive underwent splenectomy for refractory immune thrombocytopenia. Eight patients had thrombocytopenia only, and 7 others were pancytopenic prior to splenectomy. Three of the 15 patients fulfilled criteria for acquired immunodeficiency syndrome before splenectomy, and acquired immunodeficiency syndrome developed in 5 patients during the follow-up period. The median duration of thrombocytopenia prior to surgical therapy was 6 months. A bone marrow biopsy specimen showed hypercellularity with increased megakaryocytes. All patients had a therapeutic response to splenectomy. Long-term remission from thrombocytopenia/pancytopenia was achieved in 14 of the 15 patients during a follow-up period of 2 to 21 months. Splenectomy can be accomplished with an acceptable morbidity. Pneumonia developed postoperatively in 2 patients, but they did not manifest the characteristic picture of overwhelming postsplenectomy sepsis. They had received vaccinations against encapsulated organisms preoperatively. We conclude that splenectomy provides a durable and lasting response for HIV-related thrombocytopenia. Vaccination for Streptococcus pneumonia and Haemophilus influenzae should be given prior to splenectomy although its efficacy is not clear in this group.
免疫性血小板减少症是人类免疫缺陷病毒感染临床谱中一个广为人知的部分。1985年11月至1988年2月，15例人类免疫缺陷病毒阳性患者因难治性免疫性血小板减少症接受了脾切除术。8例患者仅有血小板减少症，另外7例在脾切除术前全血细胞减少。15例患者中有3例在脾切除术前符合获得性免疫缺陷综合征标准，5例在随访期间发生了获得性免疫缺陷综合征。手术治疗前血小板减少症的中位持续时间为6个月。骨髓活检标本显示细胞增多，巨核细胞增加。所有患者对脾切除术均有治疗反应。在2至21个月的随访期内，15例患者中有14例实现了血小板减少症/全血细胞减少症的长期缓解。脾切除术可以在可接受的并发症发生率下完成。2例患者术后发生肺炎，但未表现出典型的暴发性脾切除术后败血症症状。他们术前已接种针对包膜菌的疫苗。我们得出结论，脾切除术对与HIV相关的血小板减少症提供了持久的反应。尽管在该组中其疗效尚不清楚，但应在脾切除术前接种肺炎链球菌和流感嗜血杆菌疫苗。
