Immune thrombocytopenic purpura splenectomy

Observational studies In a retrospective study of the effects of dapsone 100 mg/day for at least 30 days in 52 adults with immune thrombocytopenic purpura, in whom first-line therapy with glucocorticoids had failed [43 ]. Dapsone resulted in a sustained increase in platelet count in 23 patients after a median follow-up of 21 months and none of those who responded required splenectomy compared with 20 of the other 29. Dapsone-related adverse events were mild and were promptly reversed by withdrawal. 

A 34-year-old woman with immune thrombocytopenic purpura was treated with splenectomy and was immunized against pneumococci, meningococci, and Haemophilus influenzae type b. She had been well for 3 years, but 2 weeks after a first dose of tick-borne encephalitis vaccine (FSME-Immun, Baxter ), her platelet count fell to 37 x 10 /l. She was given dexamethasone 40 mg/day for 4 days and her platelet count normalized and remained stable. 

Kumar S, Diehn FE, Gertz MA, Tefferi A (2002) Splenectomy for immune thrombocytopenic purpura long-term results and treatment of postsplenectomy relapses. Ann Hematol 81 312-319... 

Schwartz J, Leber MD, Gillis S, Giunta A, Eldor A, Bussel JB (2003) Long term follow-up after splenectomy performed for immune thrombocytopenic purpura (ITP). Am J Hematol 72 94-98... 

Kahn MJ, McCrae KR (2004) Splenectomy in immune thrombocytopenic purpura recent controversies and long-term outcomes. Curr Hematol Rep 3 317-323... 

Idiopathic thrombocytopenic purpura is an immune-mediated disease in which immunoglobulin, either as antibody directed against platelet antigens or nonspecifically bound to platelets, is present in increased quantities on platelets. This leads to increased destruction of platelets and, in many instances, megakaryocytes. Standard treatment consists of corticosteroids and splenectomy (72). When these measures fail, treatment may include androgenic steroids, administration of intravenous 7-globulin, or injection of vinca alkaloids. 

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