The results of splenectomy for purpura hæmorrhagica

Abstract

HOUSE PHYSICIAN, RIhDICAL UNIT, BT. BARTHOLONEW'S HOSPITAL.Trm operation of splenectonip in the treatment of purpura hzniorrhagica was performed for t h e first time in 1916 by K a~n e l s o n ,~~ who argued t h a t the h;emorrhages were the result of the constant reduction in the number of blood platelets, or thrombocytes, and that this reduction was brought about by the destructive action of a diseascd spleen. He suggested the name ' thrornbocytolytic purpura '. Frank26 also advised splenectomy, but on different grounds-namely, t h a t the reduction in platelets was due to an inhibitory action of the spleen on the bonc-marrow, and for this reason called the disease 'essential thrombopcnia'. As pointed out by K~s t e r ,~~ experimental evidcncc favours Kaznclson's view : " 'iYere the platelets not formed in sufficicnt numbers, the amount of thromboplastic substance furnished t o the blood by their destruction would be insufficicnt t o cause prompt coagulation. Thc coagulation time, however, in this disease remains normal ".Following in the wakc of Frank and Kaznelson, many observers have. performed splenectomy in the treatment of purpura hzemorrhagica, and have reported good results accruing therefrom. It is thought advisable, thercfore, t o report the following two cases in which splenectomy was performed : tlie one, in which there was no recurrence of hzemorrhages a€ter a period of eight m o n t h ; the other, in which splenectomy had no effect on their occurrcnce.

ITP: a historical perspective

“…By 1926, Whipple was able to collect data from about 81 patients who had undergone splenectomy for ITP (Whipple, 1926). Two years later Spence collected 23 additional records (Spence, 1928), and in 1932 Eliason and Ferguson brought the collected experience to 213 cases (Eliason & Ferguson, 1932). At that time splenectomy was clearly established as the only definitive therapeutic procedure for ITP.…”

Treatment of Thrombocytopenic Purpura

“…Three of the latter recovered completely, but five were unimproved and two were only slightly better. Splen- Spence, 1928;and Brown and Elliott, 1936). There is usually a definite pre-operative rise, though not necessarily to normal figures, followed by a fall, the count being then maintained at a low level.…”

“…Until recently it has been thought that the operation risk in acute cases was too great to justify splenectomy in fulminating purpura. Whipple (1926) records seven deaths in eight acute cases at operation, Spence (1928) ten deaths in twelve cases. Eliason (1932), however, in twenty-two patients splenectomized during a fulminating attack between 1928 and 1932, found the mortality had dropped to 13.6 per cent., a figure accepted as representative of modern results by Brown and Elliott (1936).…”

“…(Stephan, 1920;Bucky and Guggenheimer, 1922;Gragert, 1921 ;Hippe and Kochmann, 1932). Many of the early case reportsOCT.…”