RESULTS IN THE TREATMENT OF IDIOPATHIC THROMBOCYTOPENIC PURPURA

Fourteen patients with idiopathic thrombocytopenic purpura (ITP) treated with splenectomy in a recent 12 year period from January 1977 to October 1989 have been studied to clarify the effectiveness of splenectomy and the time when its longterm results can be judged. The patients comprised of 5 males and 9 females, with an average age of 39 years old. After splenectomy the numbers of platelets increased in all cases, and in 93% of them the number became more than 50, 000/mm3. The maximum levels were seen in two weeks after splenectomy. Eight out of the fourteen cases (57%) kept their increased platelet levels even more than one month after splenectomy. On the other hand, in six cases the numbers of platelets decreased within a month so that they needed some additive treatments besides surgery. Preoperative injections of γ-globulin were effective in 83% of the patients. In our experiences, a recurrence of thrombocytopenia caused by an accessory spleen was observed, which could be improved by reoperation.These results suggest that splenectomy is effective in about 60% of ITP patients, and we can predict the effect of splenectomy within a month after surgery. However, because of a possible recurrence of thrombocytopenia due to an accessory spleen we have to follow the ITP patients for long time after splenectomy.