Clinical Outcome and Predictive Factor of Splenectomy in Patients with Idiopathic Thrombocytopenic Purpura

ABSTRACT

PURPOSE: Splenectomy is an important treatment modality for the patients with idiopathic thrombocytopenic purpura (ITP), but the response rate of splenectomy for ITP patients is variable and the predictive factors of the postoperative response are uncertain. The purpose of this study is to investigate the response rate of splenectomy and find the predictive factors of splenectomy in ITP patients. METHODS: We reviewed the medical records of 54 consecutive patients who underwent splenectomy and were followed up. A positive response to splenectomy was defined as a postoperative platelet count greater than 50, 000/microliter without medication. We analyzed the following variables to find the predictive factors for splenectomy; age, gender, disease duration, platelet count at diagnosis, preoperative platelet count, early response to steroid, IVIG response, operative method, accessory spleen and postoperative platelet count. RESULTS: The response rate of splenectomy was 60% at the 1st postoperative month, 46% at the 3rd postoperative month and 37% at the 6th postoperative month. The age of the splenectomy responders at the 6th postoperative month was significantly lower than that of the non-responder (33.4+/-14.5 years versus 48.7+/-17.1 years, p< 0.05). The platelet count at the time of discharge of the splenectomy responders was significantly greater than that of the non-responders (378, 429+/-272, 399/microliter versus 191, 731+/-151, 435/microliter, p< 0.05). These results were significant on multivariate analysis. CONCLUSION: The response rate of splenectomy is decreased according to the passage of time during the early postoperative period, so long term follow up is important to investigate the predictive factors. Young age for the patients and high platelet count at discharge can be used as the predictive factors for splenectomy in ITP.