Splenectomy for immune thrombocytopenic purpura

Of 481 splenectomies performed at the University of Utah, Salt Lake City, 78 (16.2%) were for immune (idiopathic) thrombocytopenic purpura (ITP). The mean platelet count prior to therapy was 13,800/cu mm (range, 500 to 80,000/cu mm). All but two patients were initially treated with corticosteroids, and 58.2% responded with an increase in platelets (mean, 77,900/cu mm). The indications for splenectomy included (1) failure to respond to steroids (33.8%); (2) inability to taper steroids (52.1%); (3) recurrent ITP (5.6%); and (4) miscellaneous (8.5%). There was one death following splenectomy, and the postoperative morbidity was 14.1%. Complete remission occurred in 77.3%, and 84.8% were judged to have benefited from the procedure. The remission rate following splenectomy in patients who responded to preoperative steroids was 93.2%, whereas improvement fell to 68.3% in patients who failed to respond to steroids. This study confirms the benefit of splenectomy for ITP and demonstrates a predictive correlation with response to preoperative preparation with corticosteroids in these patients.