Splenectomy Done during Hematologic Remission To Prevent Relapse in Patients with Thrombotic Thrombocytopenic Purpura
- Mark A. Crowther, MD;
- Nancy Heddle, MSc, ART;
- Catherine P.M. Hayward, MD, PhD;
- Theodore Warkentin, MD; and
- John G. Kelton, MD
- From McMaster University Medical Centre and the Canadian Red Cross Blood Transfusion Service, Hamilton, Ontario, Canada. Grant Support: In part by a grant from the Heart and Stroke Foundation of Canada. Dr. Kelton is a Career Investigator for the Heart and Stroke Foundation of Ontario. Requests for Reprints: John G. Kelton, MD, McMaster University Medical Centre, 1200 Main Street West, HSC-3X28, Hamilton, Ontario L8N 3Z5, Canada. Current Author Addresses: Dr. Crowther: Hamilton Civic Hospitals Research Centre, 711 Concession Street, Hamilton, Ontario L8V 1C3, Canada.
Abstract
Objective: To assess whether splenectomy done during hematologic remission reduces the relapse rate in patients with relapsing thrombotic thrombocytopenic purpura.
Design: Consecutive case series.
Setting: Tertiary care teaching hospital.
Patients: 6 consecutive patients seen during a 10-year period who had had one or more relapses of thrombotic thrombocytopenic purpura.
Interventions: All patients had elective splenectomy while in hematologic remission and were followed after surgery for as long as 8.0 years.
Measurements: Attack rates (events per year) were calculated for each patient from time of presentation to time of splenectomy and from time of splenectomy to January 1996.
Results: A total of 26 episodes of thrombotic thrombocytopenic purpura occurred over 22.3 patient-years before splenectomy. After splenectomy, 3 acute episodes occurred over 22.7 patient-years. The attack rate (± 1 SD) decreased from 2.3 ± 2.0 events per year to 0.1 ± 0.1 events per year.
Conclusion: In patients who have had one or more relapses of thrombotic thrombocytopenic purpura, splenectomy done during hematologic remission reduces the frequency of acute relapse and the resulting need for medical therapy.
- Copyright ©2004 by the American College of Physicians
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