Thrombocytopenic purpura in parenteral drug abusers

Twenty heterosexual men considered to be at risk for developing the acquired immunodeficiency syndrome because of parenteral drug abuse underwent splenectomy for steroid resistant thrombocytopenia during a recent 34 month period. Increased bruising, ecchymoses petechiae and occasional epistaxis, together with markedly elevated levels of platelet associated immunoglobulin, were characteristic findings. There was no operative mortality, and the morbidity rate was 25 per cent. Accessory spleens were removed in five patients. Platelet counts rose to normal levels or higher postoperatively in all patients, and this response was sustained for one month to 25 months in 13 of 15 patients for whom this information is available. Thrombocytopenia in parenteral drug abusers can be safely and promptly corrected by splenectomy, and although more information is needed, it seems likely that this response will be maintained in most of these patients.