Splenectomy during partial remission in thrombotic thrombocytopenic purpura with prolonged plasma exchange dependency

Some patients with thrombotic thrombocytopenic purpura (TTP) remain plasma- exchange-dependent for prolonged periods of time. This exposes patients to risk, uses substantial resources, and requires prolonged hospitalization. W e have splenectomized 7 such patients following 25-42 plasma exchanges whil e patients were in partial remission only and were clinically stable. In 6 patients, including 1 with TTP secondary to mitomycin C, thrombocytopenia p romptly resolved. Relapse has not occurred during 18 or more months of obse rvation. The seventh patient did not respond. We conclude that splenectomy should be considered as an alternative to continued plasma-exchange therapy in such patients. Am. J. Hematol. 62:56-57, 1999. (C) 1999 Wiley-Liss, Inc .