Histology of the spleen in immune thrombocytopenia: clinical-pathological characterization and prognostic implications.
clinical-pathological correlations
histology
immune thrombocytopenia
spleen
Journal
European journal of haematology
ISSN: 1600-0609
Titre abrégé: Eur J Haematol
Pays: England
ID NLM: 8703985
Informations de publication
Date de publication:
Feb 2021
Feb 2021
Historique:
received:
18
08
2020
revised:
05
11
2020
accepted:
09
11
2020
pubmed:
16
11
2020
medline:
29
7
2021
entrez:
15
11
2020
Statut:
ppublish
Résumé
Immune thrombocytopenia (ITP) is an acquired disorder, characterized by immune-mediated platelet destruction. The spleen plays a key pathogenic role in ITP and splenectomy is a valuable second-line therapy for this disease. Little is known on ITP spleen histology and response to splenectomy is unpredictable. This study aims to characterize ITP spleen histology and assess possible predictors of splenectomy outcome. A series of 23 ITP spleens were retrospectively assessed for the following histological parameters: density of lymphoid follicles (LFs), marginal zones (MZs), T helper and cytotoxic T cells; presence of reactive germinal centers (GCs); width of perivascular T cell sheaths; and red pulp features. Clinical and histological data were matched with postsplenectomy platelet counts to assess their prognostic relevance. Three histological patterns were documented: a hyperplastic white pulp pattern, a non-activated white pulp pattern (lacking GCs), and a white pulp-depleted pattern. Poor surgical responses were associated with presplenectomy high-dose steroid administration, autoimmune comorbidities and low T follicular helper cell density. The combination of such parameters stratified patients into different splenectomy response groups. The removal of accessory spleens was also associated with better outcome. ITP spleens are histologically heterogeneous and clinical-pathological parameters may help predict the splenectomy outcome.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
281-289Informations de copyright
© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
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