Outcome of Splenectomy On Adult Idiopathic Thrombocytopenic Purpura (ITP)

To study outcome of splenectomy on adult ITP patients (both in prospective and retrospective groups)

Two groups of ITP patients were studied. They were as follows:

(i) Retrospective group – Twenty two patients who underwent splenectomy during last twenty one years

(ii) Prospective group – All patients admitted during last three years with a minimum follow-up of six months (29 patients)

Retrospective group: Twenty two patients had undergone splenectomy during last twenty one years. Median time from diagnosis to splenectomy was 32 months. Median platelet count was 28,000/μl with some form of drug treatment (before undergoing splenectomy). Median post-splenectomy follow-up was 54 months (maximum 252 months). Eleven (50%) patients had either primary failure or relapse following splenectomy during subsequent years. The cumulative break-up figure was as follows:

Primary failure – 3 (13.6%)

At 24 months – 7 (31.8%)

At 5 years – 9 (40.9%)

At 10 years – 11(50%)

Prospective group: Out of 29 patients of ITP enrolled according to inclusion criteria of minimum six months’ follow-up, 20 had complete remission with steroids; nine had primary failure. Out of 20 patients with complete remission, two had relapse within six months of remission. Out of total 11 patients with failure to response to steroids (nine primary failure and two secondary failure), six patients agreed to undergo splenectomy. Three patients had complete remission till last follow-up (maximum follow-up was for 23 months). Two had primary failure following splenectomy and one had relapse. Five patients who did not agree for splenectomy are in complete or partial remission with azathioprine.

At the end of two years in retrospective group, almost one-third of 22 patients who underwent splenectomy had either primary failure or relapse. Similarly in prospective group, though small in number, at the end of 23 months itself, three of six patients who underwent splenectomy had either no response or had relapsed. Thus this study questions the utility of splenectomy as second-line treatment after steroid failure. Rather, patient may be given a choice to opt for other form of drug treatment after steroid failure and advised splenectomy as and when unavoidable. Nevertheless, any patient opting for splenectomy should be cautioned that there is a fair chance of relapse later in life. Furthermore, it appears incidence of relapse following splenectomy is higher in Indian patients as compared to that in the Western patients.

No relevant conflicts of interest to declare.