Splenectomy for idiopathic thrombocytopenic purpura: A five-year retrospective review

Idiopathic thrombocytopenic purpura is a condition that is characterized by persistently low platelet counts. Idiopathic thrombocytopenic purpura resu lts from splenic sequestration and accelerated platelet destruction mediate d by antiplatelet antibody. Most cases arise in previously healthy patients , mostly women ages 20 to 40, Clinical symptoms consist of bruising, petech iae, mucosal bleeding, menorrhagia, and intracranial bleeding. Platelet-ass ociated immunoglobulin G can be detected in 90 per cent of patients. Therap y for adults and children is somewhat different. Splenectomy in adults shou ld be considered in patients who fail to respond to steroids, develop throm bocytopenia after taper, or develop steroid toxicity. Ninety per cent of ch ildren will maintain normal platelet counts in 9 to 12 months. Some will re cover spontaneously without medical therapy. Splenectomy in children is rec ommended if idiopathic thrombocytopenic purpura persists for more than one year or fails to respond to steroids. Our purpose was to determine whether management of idiopathic thrombocytopenic purpura in patients who undergo s plenectomy at our institutions is appropriate and effective. We undertook a 5-year retrospective review of 27 patients with idiopathic thrombocytopeni c purpura which have undergone splenectomy. All of the 27 patients were ref erred to surgeons after initial medical management. The patients were divid ed into two groups on the basis of length of therapy: longer than 6 months and less than 6 months. The longer than 6 months group contained 15 patient s. This group had a postoperative complication rate of 40 per cent. Those i n the group with <6 months therapy had a complication rate of 7 per cent. A verage follow-up for all patients was 20 months. Eighty-eight per cent of t he patients had complete response. Three per cent had a partial response wi th platelet counts >50,000. The partial response group did not respond well to preoperative steroid boluses with a great rise in platelet counts. Eigh teen per cent of patients received platelet transfusions. Sixty per cent of the transfusions were given for inappropriate reasons. A large percentage of our patients had prolonged medical therapy before splenectomy. The inapp ropriate use of platelets was a common error in management. Patients treate d for more than 6 months had more postoperative complications. An initial i ncrease in platelets after steroid bolus is a good indicator for favorable response to splenectomy. We conclude that splenectomy is a safe and effecti ve method of treatment for idiopathic thrombocytopenic purpura with no deat hs or postsplenectomy sepsis to date.