Splenectomy in Patients with Immune Thrombocytopenic Purpura

Kim, Tae Hyun; Choi, Chang Soo; Choi, Young Kil

Abstract

A splenectomy is the main therapeutic choice for immune thrombocytopenic purpura. The authors reviewed 31 cases of patients with immune thrombocytopenic purpura that had been treated by a splenectomy during a period of 15 years and assessed the clinical characteristics, the responses to the splenectomy, and the factors affecting the long-term prognosis. There were 9 males and 22 females, and the mean age was 20.8 years. The average duration of the symptoms was 20.2 months. All but one patient received preoperative steroid therapy 19 were steroid dependent, and 11 steroid refractory. The mean platelet count at first examination was 18,900/mm3, and increased to 119,900/mm3 at the time of operation. Preoperative immunoglobulin was effective in 50.0% of the patients. Postoperatively, one case of pulmonary atelectasis developed. There was no operative mortality. The clinical response rate after the splenectomy was 80.6%(complete response 64.5%, partial response 16.1%). In the steroid-dependent patients, the response rate was superior to that in the steroid refractory patients(89.5% vs 63.7%, p<0.05). Patients younger than 15 years showed a higher response rate(92.3% vs 72.2%), but this difference was statistically insignificant. Among the patients with no response to the splenectomy, 75.0% showed a clinical response with postoperative administration of steroid and other immunosuppressive drugs. Patients with a higher platelet count at the immediate postoperative period had a better long-term prognosis. A splenectomy is safe and effective in both steroid-dependent and steroid-refractory immune thrombocytopenic purpura. In patients with no respose to the splenectomy, a better result is expected through postoperative medical treatment.