SPLENECTOMY IN CHRONIC IDIOPATHIC THROMBOCYTOPENIC PURPURA

Twelve patients with chronic idiopathic thrombocytopenic purpura underwent splenectomy. Treatment with prednisone was unsuccessful. The average time of follow up was 80.2 +/- 70.1 (12 - 270) months. Immediately after splenectomy, complete response (platelets more than 140 x 10(9)/L) was obtained in 8/12 (66.6%), partial response (platelets 50 - 140 x 10(9)/L) in 2/12 (16.6%), and no response in 2/12 (16.6%) patients. At the end of the long term follow up (12 - 270 months) the persistent complete response rate was 9/12 (75%) and persistent failure of splenectomy 1/12 (8.3%). Postsplenectomy thrombocytosis is probably the only feature of long lasting response. During the first year after splenectomy the clinical course of chronic idiopathic thrombocytopenic purpura is unpredictable. There were no operative mortality and no infections during the long term follow up period. These data support continuing use of splenectomy in selected patients with chronic idiopathic thrombocytopenic purpura.