Chronic Idiopathic Thrombocytopenic Purpura: Effective preoperative preparation and long-term results of splenectomy

A retrospective review of 98 patients seen at Henry Ford Hospital from 1953 through 1977 demonstrated that splenectomy for chronic idiopathic thrombocytopenic purpura provided a good response which usually was sustained on long-term follow-up (72% at 15 years). Although splenectomy for this condition had a low mortality, morbidity was significant in patients older than 40 years. When compared to patients whose response to splenectomy was sustained, patients who relapsed had significantly lower platelet counts preoperatively both when they were untreated (mean: 9,194 per cc versus 18,524 per-cc) and/or when they were treated with steroids (mean: 85,647 per cc versus 142,590 per cc). Another significant risk factor for relapse was a longer interval from splenectomy to the maximum postoperative platelet count. In the immediate preoperative preparation of the patient for splenectomy, corticosteroids temporarily increased the platelet count, but high doses were necessary in many patients. A platelet count of greater than 40,000/cc usually was achieved with a dose of 60 to 80 mgs of prednisone per day for several days. Platelet infusion rarely was needed if patients were prepared adequately with steroids. There should be no hesitation to give large doses of steroids for a few days, and a delay in proceeding with the operation, once indicated, should be avoided. Because the response of the platelet count to splenectomy may be variable or fluctuating and late relapses can occur, patients should be re-evaluated periodically