Experience with splenectomy in auto-immune thrombocytopenia and agnogenic myeloid metaplasia

In a 5-year period 37 patients with auto-immune thrombocytopenic purpura (AITP) and 22 with agnogenic myeloid metaplasia (AMM) underwent splenectomy. In 26 of the patients with AITP (70%) a satisfactory response was obtained, although there was 1 death a year later as a result of infection. In 6 cases (16%) significant postoperative haemostatic problems were experienced. Seventeen of the patients with AMM (77%) improved as a result of the operation, but 3 of them (14%) died in the postoperative period. During the follow-up period a further 4 patients died (18%). Haemorrhagic complications occurred in 7 patients (32%), of whom 2 died immediately after the operation. Haemostatic screening procedures during this whole period failed to predict the risk of postoperative haemorrhage, and in neither group did prophylactic platelet infusion significantly reduce haemorrhagic complications.