Immunodeficiency-associated thrombocytopenic purpura (IDTP). Response to splenectomy
P. A. Schneider, D. I. Abrams, A. A. Rayner and D. C. Hohn
Department of Surgery, University of California-San Francisco 94143.
Immunodeficiency-associated thrombocytopenic purpura (IDTP) is a feature of
the acquired immunodeficiency syndrome--related complex. Current
therapeutic modalities for IDTP include splenectomy and the administration
of corticosteroids or other agents. Empiric treatment of IDTP has been
analogous to that for immunologic thrombocytopenic purpura (ITP). The
present report reviews 15 patients who underwent splenectomy for IDTP,
demonstrates the successful use of surgical therapy, and defines our
indications for splenectomy in the treatment of this disorder. Thirteen of
15 patients had initially failed to respond to steroid therapy. Fourteen
patients (93%) initially responded to splenectomy, with platelet counts
increasing to 150 X 10(9)/L (150,000/mm3) or greater. A continuing complete
response was achieved in nine patients (60%) following splenectomy. After
postsurgical adjunctive therapy, durable remission was achieved in 73%
(11/15) of the patients. Complications occurred in three patients, and
there were no deaths. The mean follow-up was 12.4 months. Splenectomy may
be performed in the treatment of IDTP with acceptable morbidity and
likelihood of response.
