Splenectomy done during hematologic remission to prevent relapse in patients with thrombotic thrombocytopenic purpura

To assess whether splenectomy done during hematologic remission reduces the relapse rate in patients with relapsing thrombotic thrombocytopenic purpura.

Consecutive case series.

Tertiary care teaching hospital.

6 consecutive patients seen during a 10-year period who had had one or more relapses of thrombotic thrombocytopenic purpura.

All patients had elective splenectomy while in hematologic remission and were followed after surgery for as long as 8.0 years.

Attack rates (events per year) were calculated for each patient from time of presentation to time of splenectomy and from time of splenectomy to January 1996.

A total of 26 episodes of thrombotic thrombocytopenic purpura occurred over 22.3 patient-years before splenectomy. After splenectomy, 3 acute episodes occurred over 22.7 patient-years. The attack rate (+/-1 SD) decreased from 2.3 +/- 2.0 events per year to 0.1 +/- 0.1 events per year.

In patients who have had one or more relapses of thrombotic thrombocytopenic purpura, splenectomy done during hematologic remission reduces the frequency of acute relapse and the resulting need for medical therapy.