Splenectomy for thrombocytopenia.

Of 478 patients who underwent splenectomy for hematologic disease between 1947 and 1978, 142 had thrombocytopenia as the dominant indication, while in 32 this was an associated preoperative factor. Of 120 patients with idiopathic thrombocytopenic purpura (ITP) 88% had long-term remission subsequent to removal of the spleen. Ninety percent of the responders had normal platelet counts at the end of 1 week subsequent to the operation. Six of 13 patients with thrombotic thrombocytopenic purpura (TTP) were long-term survivors and were considered cured. Thrombocytopenia, associated with a variety of disorders, as a dominant indication for splenectomy was improved significantly in the majority of cases. The same results were noted when thrombocytopenia was an associated factor. Postoperative death usually was related to intracerebral bleeding, and no increased incidence of thromboembolic disease or sepsis was noted. Electron microscopic evaluations of the spleens defined marked platelet sequestration in patients with ITP and TTP.