Splenectomy for Chronic Idiopathic Thrombocytopenic Purpura

Ralph C. Wilde, MD; Lawrence D. Ellis, MD; William M. Cooper, MD
Arch Surg. 1967;95(3):344-350. doi:10.1001/archsurg.1967.01330150020004.
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THERE has been some controversy regarding the proper management of chronic idiopathic thrombocytopenic purpura (ITP) since 1950.1 During this period, the treatment of choice has made a complete cycle. Initially, splenectomy was the only modality of treatment which produced a reasonable percentage of lasting remissions. Because of low remission rates in the 50% to 60% range, and because of the rather high mortality and morbidity of the procedure, the medical profession wished to find a more effective method of treatment. The discovery of the therapeutic benefits of corticosteroids in autoimmune disorders provided a possible solution. For several years steroids enjoyed popularity as the treatment of choice, and splenectomy was reserved only for those patients in whom long-term medical management failed. Unfortunately, prolonged remission rates with steroids were no higher than 35% to 50%.2 In addition, the undesirable complications of long-term steroid therapy, namely, acne, osteoporosis, peptic ulceration, moon


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