Factors predicting response to splenectomy in adult patients with idiopathic thrombocytopenic purpura

Background and Objectives. Splenectomy is the treatment of choice in the ma jority of patients affected by idiopathic thrombocytopenic purpura refracto ry to corticosteroid therapy, but it is not free from early and late compli cations. As the available literature does not seem to contain any precise i ndications concerning possible factors predicting the response to splenecto my, the aim of this retrospective study of 65 splenectomized patients was t o attempt to identify potentially predictive clinical or laboratory paramet ers. Design and Methods. For the purposes of statistical analysis, the patients were divided into two groups: the first included those with a complete (pla telets > 100x10(9)/L) or partial response (platelets 50-100 x10(9)/L) to sp lenectomy; the second, the non-responders (platelets < 50x10(9)/L). The non -parametric tests were based on the Kruskal-Wallis method for independent s amples, and the independent samples were compared using the Chi-square test according to Pearson. Results. Univariate analysis did not reveal any significant correlation bet ween successful splenectomy and age, sex, platelet count at diagnosis, anti ,platelets antibody positivity, the site of platelet :sequestration, the ti me between diagnosis and surgery, or the response to high intravenous immun oglobulin doses. However, the probability of success was greater in the pat ients with a complete or partial pre-operative response to steroid therapy (p<0.05). Interpretation and Conclusions. The factor most frequently associated with the success of splenectomy is the site of autologous platelet sequestration . Our study did not identify any clinical or laboratory parameter clearly p redictive of post-splenectomy cure other than a transient response to stero id treatment. this finding needs further confirmation in larger patient pop ulations. (C)2000, Ferrata Storti Foundation.