Reevaluation of the prognostic factors for splenectomy in chronic idiopathic thrombocytopenic purpura (ITP): A report on 181 cases

Abstract

From 1973 to 1986 we splenectomized 181 patients with chronic ITP after platelet kinetic studies with 51Cr or 111In. Mean age at diagnosis was 34 (range 4–79 yr). Follow‐up of at least 1 yr after splenectomy was available in every patient. 141 patients (78%) achieved remission (platelets > 100 times 109/1 by 3 months after splenectomy), of whom 9 subsequently relapsed. Among the 40 non‐responders at 3 months, 3 achieved a later remission spontaneously. Factors associated with response to splenectomy included a high post‐operative platelet count (p = 0.0001), younger age at the time of surgery (p = 0.0077) and predominantly splenic sequestration of platelets (p = 0.0002), the two latter factors being partially correlated. In a multivariate analysis, however, only post‐operative platelet count and age retained an independent prognostic significance, whereas the sequestration site of platelets had only borderline value. These results are discussed in the context of indications of platelet kinetic studies in chronic ITP, before splenectomy is considered.

Long-term outcome following splenectomy for chronic and persistent immune thrombocytopenia (ITP) in adults and children

“…Factors influencing response included female sex, previous steroid sensitivity and higher platelet counts at the time of splenectomy. Female sex, demonstration of steroid sensitivity and higher platelet counts at the time of splenectomy have been described in other series also as predictors of better response to splenectomy [12][13][14][15][16][17]. In this series, we have used high-dose dexamethasone prior to splenectomy with the presumption that higher platelet counts at the time of splenectomy will lead to a reduced incidence of postoperative bleeding.…”

Long-term Relapse-free Rurvival Rate and Predictive Factors of Idiopathic Thrombocytopenic Purpura in Adults Undergoing Splenectomy

“…The post-op platelet count was a predictive factor for response in our study but not analyzed in their reports. Fenaux et al, [23] found post-op platelet count and age retain an independent prognostic significance in multivariate analysis.…”

Long-term management of chronic immune thrombocytopenic purpura in adults

“…There is a lack of reliable tools to accurately predict the response of ITP to splenectomy. In general, younger patients respond better,32,33,36,37 but a specific age cutoff for this observation has not been determined. Splenectomy is considered a low-risk surgical procedure, especially in previously healthy patients, but it must be performed by expert surgeons.…”