Immune thrombocytolytic purpura (ITP): a diagnostic and therapeutic survey of 86 cases with regard to the results of splenectomy and conservative therapy.

Abstract

The therapeutic results in 86 cases of ITP seen over a period of 15 years are reported. Distribution of the haemorrhagic manifestations was in agreement with published data. On follow-up of the 40 splenectomized patients, the shortened platelet life-span, the reduced "recovery" as well as the increased rates of platelet turnover and platelet formation revealed a manifest tendency of normalization. One year after splenectomy the results were found "good" or "moderate" in 86%, more than two years after the intervention in 85%, of the cases. Retrospective analysis of the platelet-sequestration studies having shown "good" or satisfactory results in 93% of the splenic cases, this investigation is regarded as crucial to the indication of splenectomy. The absence of increased thrombocytopoiesis in approximately 15% of the cases is attributed to an antibody effect, reflected in a reduced polyploidy of the megakaryocytes. Normalization or increase in platelet count early after splenectomy is interpreted as a favourable prognostic sign. On the other hand, neither age of the patients nor the time of splenectomy was found to affect the success of the intervention. The results of corticosteroid treatment (Prednisolon 52%) lag far behind those of splenectomy. Ten patients were given combined immunosuppressive treatment.