Open AccessThe Role of Splenectomy in Multimodality Treatment of Thrombotic Thrombocytopenic Purpura
Author(s) -
Peter A. Schneider,
Anthony A. Rayner,
Charles Linker,
Mark A. Schuman,
Edison T. Liu,
D. Höhn
Publication year - 1985
Publication title -
annals of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.153
H-Index - 309
eISSN - 1528-1140
pISSN - 0003-4932
DOI - 10.1097/00000658-198509000-00007
Subject(s) - splenectomy , medicine , plasmapheresis , thrombotic thrombocytopenic purpura , surgery , fulminant , thrombocytopenic purpura , platelet , immunology , spleen , antibody
Current treatment modalities for thrombotic thrombocytopenic purpura (TTP) include plasmapheresis (PP), splenectomy, steroids, dextran, other antiplatelet agents, and vinca alkaloids. Prior to the development of PP and use of multimodality treatment for TTP, mortality rates exceeded 50%. This report reviews 11 patients treated for TTP, demonstrates the successful use of splenectomy as salvage therapy, and defines our indications for splenectomy in the treatment of this disorder. Ten of 11 patients were initially treated with PP; three responded completely and one died of fulminant disease. Six patients had a transient partial response to plasmapheresis and were subsequently treated with splenectomy, steroids, and dextran-70. Initial plasmapheresis resulted in improvement in laboratory values and clinical status in those patients requiring splenectomy. Durable remission (6-48 months) was achieved in 91% of patients with minimal morbidity.