Splenectomy for immune thrombocytopenic purpura
S. J. Mintz, S. R. Petersen, B. Cheson, L. J. Cordell and R. C. Richards
Of 481 splenectomies performed at the University of Utah, Salt Lake City,
78 (16.2%) were for immune (idiopathic) thrombocytopenic purpura (ITP). The
mean platelet count prior to therapy was 13,800/cu mm (range, 500 to
80,000/cu mm). All but two patients were initially treated with
corticosteroids, and 58.2% responded with an increase in platelets (mean,
77,900/cu mm). The indications for splenectomy included (1) failure to
respond to steroids (33.8%); (2) inability to taper steroids (52.1%); (3)
recurrent ITP (5.6%); and (4) miscellaneous (8.5%). There was one death
following splenectomy, and the postoperative morbidity was 14.1%. Complete
remission occurred in 77.3%, and 84.8% were judged to have benefited from
the procedure. The remission rate following splenectomy in patients who
responded to preoperative steroids was 93.2%, whereas improvement fell to
68.3% in patients who failed to respond to steroids. This study confirms
the benefit of splenectomy for ITP and demonstrates a predictive
correlation with response to preoperative preparation with corticosteroids
in these patients.
