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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
[+] Article, Author, and Disclosure Information

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.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1996;125(4):294-296. doi:10.7326/0003-4819-125-4-199608150-00006
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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.


Grahic Jump Location
Figure 1. Each patient was followed until January 1996.
Timeline for six patients with relapsing thrombotic thrombocytopenic purpura (TTP).
Grahic Jump Location




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