Indium‐labelled autologous platelet sequestration studies predict response to splenectomy in immune thrombocytopenia: an Australian experience.
- Resource Type
- Article
- Authors
- Ratnasingam, Sumita; Reid, Amy S.; Ma, Dickson; Bucki‐Smith, Daniel; Gwini, Stella M.; Seneviratna, Leah; Campbell, Philip J.
- Source
- Internal Medicine Journal. Aug2022, Vol. 52 Issue 8, p1387-1393. 7p.
- Subject
- *AUDITING
*SPLENECTOMY
*INDIUM
*BLOOD platelets
*THROMBOPENIC purpura
*RETROSPECTIVE studies
*MEDICAL care use
*RADIONUCLIDE imaging
*TREATMENT effectiveness
*PLATELET count
*DESCRIPTIVE statistics
*DISEASE remission
*EVALUATION
- Language
- ISSN
- 1444-0903
Background: Splenectomy is an effective intervention in primary immune thrombocytopenia (ITP). Attempts to define pre‐clinical predictors of platelet response to splenectomy are inconsistent. Based on international studies defining the likelihood of platelet response using platelet sequestration, patients with relapsed/refractory ITP being considered for splenectomy at a regional Australian hospital were assessed with 111indium‐labelled autologous platelet sequestration (ILAPS) studies. Aims: To audit the use of ILAPS in an Australian setting and define its role in predicting response to splenectomy. Methods: A retrospective review of all patients referred for an ILAPS study at a regional hospital was performed. Results for each patient were expressed as an 'R' value (spleen/ liver uptake ratio) to quantify the platelet sequestration pattern and outcome post‐splenectomy, based on platelet counts. Results: A total of 45 patients was identified: 13 underwent splenectomy and 32 were medically managed. Patients with favourable ILAPS scans (pure or predominant splenic sequestration) demonstrated a superior response post‐splenectomy (100% overall response rate (ORR); 83.5% complete remission (CR)) compared with those with unfavourable ILAPS scans (mixed or pure hepatic sequestration) (71.4% ORR; 57.1% CR) over 12 months. Conclusions: The use of ILAPS in the Australian setting is feasible and this experience confirms larger international studies demonstrating its utility as a predictor of response to splenectomy in ITP. An unfavourable ILAPS scan could be considered a negative predictor of response prompting consideration for other emerging ITP treatments such as thrombopoietin‐receptor agonists or B‐cell depleting therapy such as Rituximab. [ABSTRACT FROM AUTHOR]