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Background: Splenectomy is an effective treatment for chronic immune thrombocytopenia (ITP); however, patients' willingness to accept splenectomy is variable., Objective: To explore why some ITP patients accepted splenectomy when recommended by their physician while others refused., Design: Qualitative descriptive study using one-to-one, in-depth patient interviews and a team-based approach to thematic analysis., Results: Of 25 patients interviewed, 15 refused splenectomy and 10 accepted and were awaiting surgery. Themes about the influences on splenectomy decision making that emerged from patient interviews were (i) the perceived impact of ITP on quality of life, (ii) patients' view of splenectomy as a last resort treatment, (iii) patients' interpretations of the rates of treatment success and failure and (iv) a perceived lack of familiarity about ITP. Patients who accepted splenectomy perceived their disease as having a negative impact on their quality of life, whereas patients who refused felt their situation was not severe enough to warrant surgery. Patients developed their own experiential interpretations of the success rates of splenectomy quoted to them. A general lack of awareness of the clinical impact of ITP and its cause was identified by patients as barriers to choosing splenectomy., Conclusions: Patients' disease experience, perceptions of the lack of treatment alternatives, interpretations of treatment success and failure rates and a general lack of awareness about ITP influenced treatment choice. This study represents a first step towards contextualizing treatment decision making in ITP, focusing on patient preferences and values., (© 2012 John Wiley & Sons Ltd.)

Background: Immune thrombocytopenic purpura (ITP) in children is a common pediatric bleeding disorder with heterogeneous manifestations and a natural history that is not fully understood. To better understand the natural history of chronic ITP and detect response trends and outcomes of therapy, we conducted a 10-year retrospective survey of children from age 1 to 18 years with a diagnosis of chronic ITP., Results: Data on 198 patients from 8 Canadian Pediatric Hematology/Oncology centers were analyzed. The majority of patients were female (58%), and were previously diagnosed with acute (primary) ITP (85%). The age at diagnosis of chronic ITP ranged from 1.1 to 17.2 years with a mean of 8.2+/-4.4 years. Ninety percent of patients received some form of treatment. Untreated patients had a higher mean platelet count at diagnosis of chronic ITP (P=0.009) despite similarities in mean age at first presentation and mean duration of follow-up. Thirty-four (17%) patients underwent splenectomy. Splenectomized patients tended to be significantly older, had a lower mean platelet count at diagnosis of chronic ITP, and had a longer duration of follow-up., Conclusions: The results from this study are consistent with published reports.

The effect of plasma exchange (PE) for the treatment of acute immune thrombocytopenic purpura (ITP) was assessed both through an analysis of the use of PE for ITP in Canada from 1980 to 1997, and in a study of 23 patients with acute ITP. Thirteen of these 23 patients were treated by PE (10 were exchanged with albumin and three with FFP) plus prednisone and 10 were treated with prednisone alone. At the 6 month follow-up, 11 of 19 patients were considered complete responders and six were considered partial responders. The difference in response rates between the PE and prednisone groups was not statistically significant. All patients had platelet specific antibodies at the time of entry into the study. Antibody concentration was reduced following PE in 10 of the 12 patients tested, and a response to PE was seen in all 10 patients who had a reduction in the level of platelet antibody. In contrast, antibody levels did not change in the patients who received steroid treatment only. This observation suggests that antibody removal may be of direct benefit in patients with ITP. Analysis of our results indicated that PE increased the length of time before splenectomy but did not alter the need for splenectomy. Short term benefits of PE were accomplished with no increase in morbidity or mortality which confirms that PE is a safe procedure in patients with ITP.