The prognostic factors for splenectomy response were evaluated in 40 adult patients with idiopathic thrombocytopenic purpura (ITP). We defined the corticosteroid response on the basis of the platelet count after seven to ten days of therapy, rather than at some time after discontinuing corticosteroid agents, as previously reported in the literature. Initial corticosteroid response was statistically significant in predicting splenectomy response; age and sex were marginally significant; duration of symptoms and spleen weight were not predictive. Of 30 patients with a minor or complete response to corticosteroids, 28 (93percnt;) responded to splenectomy; of ten patients unresponsive to corticosteroids only four (40percnt;) responded to splenectomy (P .001). Eighty-two percent of the patients in the complete responder group are projected to be continually relapse-free at 96 months. Only one of the patients in this group died; the nonresponders to splenectomy had a median survival of only ten months.
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