title: Adult idiopathic thrombocytopenic purpura without the option of splenectomy.
abstract: In this part of Malaysia, consent of splenectomy is virtually unobtainable, so we studied the outcome of ITP without this treatment option. Thirty-two adult patients were seen, but 7 defaulted before therapy evaluation. Of the remaining 25, 17 achieved a complete remission with prednisolone, but in only 8 was this prolonged. Twelve patients, who failed to respond to prednisolone or who required > 15 mg/day as maintenance, were offered splenectomy, but all fused. Of these 12: one has died from an intracranial haemorrhage; three others have defaulted while on no treatment with platelet counts of < 16 x 10(9)/1; one has had a baby who died from intracranial bleeding. The other seven patients have platelet counts ranging from 4 - 202 x 10(9)/1 with moderate bleeding on doses of prednisolone of 0-60 mg/day: long-term corticosteroid side-effect are evident in all but one of them. This study demonstrates that ITP patients who refuse splenectomy have a high morbidity.
authors.affiliation: Department of Medicine, Hospital Universiti Sains Malaysia, Kubang, Kerian, Kelantan.
authors.forename: N
authors.initials: N
authors.lastname: Jackson
authors.forename: M
authors.initials: M
authors.lastname: Mustapha
authors.forename: A A
authors.initials: AA
authors.lastname: Baba
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003613:Danazol / Q000627:therapeutic use; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000627:therapeutic use; D011696:Purpura, Thrombocytopenic / Q000188:drug therapy*; D013156:Splenectomy; D016896:Treatment Outcome; D016312:Treatment Refusal
chemical_list: D005938:Glucocorticoids; D011239:Prednisolone; D003613:Danazol