Idiopathic thrombocytopenic purpura is an immunologically mediated destructive thrombocytopenia, and steroid and splenectomy are the main therapeutic choices for ITP.
Several factors such as age, response to steroid therapy, duration of symptom were known to be related with prognosis after splenectomy for ITP.
So, we reviewed thirty-two cases of ITP which treated by splenectomy after failure of steroid therapy at the department of surgery, Seoul national university hospital from Apr, 1982 to Dec. 1989, and to search for prognostic factors, we
statistically
analyzed several factors such as age, sex, response to steroid therapy, mean duration of symptom, serum antiplatelet antilbody accessory spleen, weight of the spleen.
@ES The results were as follows;
@EN 1) The male to female ratio was 1 : 3 and mean ages of male and female were 32.6 and 36.0 respectively.
2) Mean duration of follow-up was 24.0 months.
3) Immediately after splenectomy, complete response(platelets≥150.000/㎣) was obtained in 65.6% of patients while 31.2% had partial response(platelets 50,000~150,000/㎣) and only 1 patient had no response.
4) During the long term follow-up, the persistent complete response rate was 55.6%, while partial and no response rate were 18.5% and 25.9%, respectively.
5) Although statistically non-significant, complete response group was younger and more responsive to steroid therapy, had fewer accessory spleens and shorter duration of symptom compared to partial or no response group.
6) The preoperative negative serum antiplatelet antibody appeared to be related with prognosis after splenectomy(P=0.037).
7) The platelet recovery rate after splenectomy and postsplenectomy thrombocytosis appeared to be early features of the persistent complete response.
8) For 7 patients who were refractory to splenectomy, prednisone to 1 patient, prednisone and cyclophosphamide to 4 patients, prednisone and azathioprine to 1 patient, azathioprine, vinblastine, cyclophosphamide and Danazol to 1 patient were
administered.
Four of these cases had partial responses and three cases no response.
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