Laparoscopic splenectomy for thrombotic-thrombocytopenic purpura (Moschkowitz' disease): surgical and haematological results in two patients

History: Case 1. Thrombotic-thrombocytopenic purpura (TTP, Moschkowitz' dis ease) in a 57-year-old woman had for one year been treated conservatively. But when daily plasmapheresis was temporarily discontinued she developed be havioural changes and impaired speech, providing an indication for splenect omy. Case 2. A 53-year-old woman with TTP had been similarly treated for on e month. Splenectomy was indicated when neurological symptoms rapidly devel oped. Investigations: At admission, creatinine 110 mg/d, white cell count (WBC) 1 2.4 G/I haemoglobin 10.1 g/dl, haematocrit 0.29, platelets 91 G/I. Prothrom bin time (PTT) and thromboplastin time were normal. Patient 2. At admission , platelet count was below 10 G/I and she had various neurological abnormal ities. Haemoglobin was 9.0 f/dl, haematocrit 0.27. Platelet count, PTT, thr omboplastin time and renal functions were normal. Treatment and course: Case 1. After plasmapheresis and administration of cr yoprecipitate-free fresh frozen plasma (FFP) excess, laparoscopic splenecto my was performed. On the third postoperative day WBC count was 11.5 G/I, ha emoglobin level was unchanged, but platelet count was now normal, as were P TT and thromboplastin time and renal functions. 8 and 32 months after the o peration WBC count, haemoglobin, haematocrit and platelets were all normal. There were no neurological abnormalities postoperatively. Case 2. Laparosc opic splenectomy was performed after intensive haematological preparation. The pre- and postoperative course was uneventful and she was discharged on the 8th postoperative day, at which time her haemoglobin was 8.4 g/dl, haem atocrit 0.25, while platelets, PTT, thromboplastin time and renal functions were all normal and remained so at follow-up 11 months later. There have b een no neurological symptoms after the splenectomy. Conclusion: Laparoscopic splenectomy is a haematologically and surgically s afe treatment of TTP and should be considered for all cases of TTP that fai l to respond to conservative management.