title: Splenectomy during partial remission in thrombotic thrombocytopenic purpura with prolonged plasma exchange dependency.
abstract: Some patients with thrombotic thrombocytopenic purpura (TTP) remain plasma-exchange-dependent for prolonged periods of time. This exposes patients to risk, uses substantial resources, and requires prolonged hospitalization. We have splenectomized 7 such patients following 25-42 plasma exchanges while patients were in partial remission only and were clinically stable. In 6 patients, including 1 with TTP secondary to mitomycin C, thrombocytopenia promptly resolved. Relapse has not occurred during 18 or more months of observation. The seventh patient did not respond. We conclude that splenectomy should be considered as an alternative to continued plasma-exchange therapy in such patients.
authors.affiliation: Department of Medicine, Division of Clinical Hematology, University of Alberta, and University of Alberta Hospital, Edmonton, Alberta, Canada.
authors.forename: M J
authors.initials: MJ
authors.lastname: Mant
authors.forename: A R
authors.initials: AR
authors.lastname: Turner
authors.forename: D
authors.initials: D
authors.lastname: Bruce
authors.forename: C
authors.initials: C
authors.lastname: Ritchie
authors.forename: L M
authors.initials: LM
authors.lastname: Larratt
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects; D001241:Aspirin / Q000627:therapeutic use; D003131:Combined Modality Therapy; D017707:Erythrocyte Transfusion; D006801:Humans; D016685:Mitomycin / Q000009:adverse effects; D010951:Plasma Exchange; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D010976:Platelet Count; D011697:Purpura, Thrombotic Thrombocytopenic / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D012074:Remission Induction; D013156:Splenectomy; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D000970:Antineoplastic Agents; D010975:Platelet Aggregation Inhibitors; D016685:Mitomycin; D001241:Aspirin