The effect of mean platelet volume on bleeding and relapse time on splenectomy response in patients with primary immune thrombocytopenia

Immune thrombocytopenia (ITP) is an autoimmune disease characterized by autoantibody-mediated destruction of platelets. The aim of treatment in ITP is to provide enough platelet count to prevent bleeding. Determining the factors associated with bleeding contributes to determining the need for treatment and determining the right treatment option. In our study, it was aimed to examine the relationship between mean platelet volume (MPV) and bleeding / bleeding severity. In addition, it was planned to investigate the factors associated with splenectomy response in patients who did not respond to medical treatment and underwent splenectomy. Our study was carried out by retrospectively evaluating the files of the patients who were examined and treated with the diagnosis of ITP in the Hematology Polyclinic of the Karadeniz Technical University Faculty of Medicine Farabi Hospital between 2008 and 2018, or who requested consultation due to ITP from the Karadeniz Technical University Faculty of Medicine Farabi Hospital Hematology Department. A total of 204 patients, 139 women and 65 men, were included in the study. It was observed that 130 (63.7%) of 204 patients had signs of bleeding. Mean MPV level was 11.1 ± 1.6 fL in patients without bleeding findings, and 9.6 ± 1.5 fL in patients with bleeding findings (p <0.05). Splenectomy was performed in 37 patients, and response to treatment was observed in 27 patients (72%). The time from diagnosis to splenectomy was found to be 184 ± 156 days in patients with splenectomy response and 794 ± 1087 days in patients without splenectomy response. In patients who underwent splenectomy after relapse (n = 13), remission period; It was observed that it was 160 ± 119 days in patients with splenectomy response (n = 10), and 115, 3240, 1440 days in patients without splenectomy response (n = 3). It was found that the time from diagnosis to splenectomy (p = 0.28) and the remission period (p = 0.209) in patients with relapse were not related to splenectomy response. It was observed that IVIG was given to 27 patients who underwent splenectomy before the operation. It was observed that 20 of 27 patients had an IVIG response and 19 of 27 patients had a splenectomy response. Splenectomy response rates were found to be higher in patients with IVIG response (p = 0.034). As a result of our study, it has been shown that low MPV is a factor affecting bleeding and the presence of IVIG response is a positive indicator of splenectomy response.