Role of splenectomy in chronic idiopathic thrombocytopenic purpura

To evaluate the usefulness of splenectomy and factors which predict long term remission in chronic idiopathic thrombocytopenic purpura (ITP).

We reviewed the data of 364 patients diagnosed as chronic ITP between January 1983 to December 1996 of whom 71 patients underwent splenectomy. The patients were followed up for an average period of 58 months and the short and long term response to splenectomy were analyzed at the end of one month and 60 months, respectively.

At the end of one month after splenectomy, 82% had complete response, 7% partial response and 11% had no response. At the end of 60 months, 42% maintained complete response, 7% partial response, 34% had no response and 17% were lost to follow up. The results were statistically evaluated by using non-parametric test (Chi-square test) to age, sex, platelet count prior to treatment, initial response to steroids, time interval between diagnosis and splenectomy and post-operative platelet count. Of these factors only preoperative response to steroids (p value = 0.018303) and postoperative platelet count (p value = 0.013536) were found to be significant, statistically to predict long term remission. Age, sex, initial platelet count and time interval between diagnosis and splenectomy didn't seem to be statistically significant.

This study suggests, that patients with an initial complete response to steroids and a post-operative platelet count > 300 x 10(9)/L at the time of discharge were associated with a long term remission. Splenectomy in ITP is a safe procedure with minimal morbidity and mortality and gives a good long term remission in steroid- failure patients with chronic ITP.