SURGICAL TREATMENTS OF CHRONIC IDIOPATHIC THROMBOCYTOPENIC PURPURA AND PROGNOSTIC FACTORS FOR SPLENECTOMY

To determine the prognostic factors for splenectomy in patients with c hronic idiopathic thrombocytopenic purpura (ITP), 26 consecutive patie nts who had undergone splenectomy as a treatment for ITP in the last 2 0 years were investigated retrospectively. Predictive values of age, s ex, the interval between diagnosis and surgery, presence of antiplatel et antibodies or accessory spleen, bleeding time, response to corticos teroids, response to high-dose immunoglobulin, weight of spleen, serum platelet-associated immunoglobulin G, preoperative maximal platelet c ount, and preoperative minimal platelet count were examined with multi variate analysis by multiple regression. Age less than 50 years at sur gery, platelet count of 100x10(9)/l or more in response to high-dose i mmunoglobulin, and a maximal platelet count of 100x10(9)l or more befo re splenectomy were favorable prognostic factors (p<0.05). The correla tion coefficient, sensitivity, specificity, and positive-predictive va lue of the analyzed multiple regression based on prognostic factors we re 0.885, 68.8%, 85.7% and 91.7%, respectively. In conclusion, splenec tomy is an effective treatment for younger patients, large maximal pre operative platelet counts and preoperative immunoglobulin dependence. Multivariate function analysis was useful for predicting outcome.