THROMBOTIC THROMBOCYTOPENIC PURPURA - INDICATIONS FOR AND RESULTS OF SPLENECTOMY

BACKGROUND: Thrombotic thrombocytopenic purpura (TTP) is a rare, life- threatening disorder of unknown pathophysiology. The role of splenecto my in the multimodality therapy of TTP is controversial. MATERIALS AND METHODS: All charts of patients with TTP at the University of Utah be tween 1984 and 1994 were reviewed to evaluate various treatment regime ns, and specifically, the impact of splenectomy on morbidity and survi val. RESULTS: Of the 15 patients identified, 14 underwent initial trea tment with plasmapheresis and steroids. Nine patients were treated wit h medical therapy only, 6 of whom completely recovered, while 3 patien ts. Six patients failed plasmapheresis and underwent splenectomy. Ther e were no operative complications or postoperative deaths. All surgica l patients had no active disease at last follow-up. CONCLUSION: Plasma pheresis and steroid administration remain the first-line therapy for TTP. This series documents that splenectomy offers excellent results w ith minimal morbidity and mortality in patients who do not respond to or who relapse after plasmapheresis.