Splenectomy for thrombotic thrombocytopenic purpura

A retrospective analysis of eleven patients with documented thrombotic thrombocytopenic purpura treated at The Mount Sinai Hospital from 1967 to 1979 is presented. Ten patients demonstrated an acute form of the disease, whereas one patient had chronic thrombotic thrombocytopenic purpura. All patients demonstrated microangiopathic anemia, renal dysfunction and thrombocytopenia. Ten patients had fever and neurologic symptoms. Preoperative management consisted of high-dose intravenous steroids in all patients. Eight patients received Dextran 70, and three patients dipyridamole and aspirin. Splenectomy was performed on all patients. Of the nine patients treated with steroids, platelet deaggregators, and splenectomy, six survived (66%). All survivors were off medication and well in follow-up performed from two to twelve years after splenectomy. Initial platelet counts below 25,0000/mm ³, age above 40, or any elevation of total serum bilirubin adversly affected survival in this series.