Controversy Over Splenectomy for Persistant ITP
A reader brought to our attention the controversial nature of the last sentence in the abstract on idiopathic thrombocytopenic purpura (ITP) in the March issue of PIR (2:294,1981). The articles from which the abstract was prepared noted that when ITP has persisted for more than one year with low platelet counts, splenectomy has resulted in a rise of platelet count in normal levels in about 66% of patients. Other workers have shown that spontaneous resolution of ITP will occur in most instances without the need of surgery, but the disease may persist longer than one year. The hazards of the postsplenectomy syndrome are well known, and prudence would dictate that one wait indefinitely in an asymtomatic child before carrying out this procedure. (Ramos MEG, Newman AJ. Gross S: Chronic thrombocytopenia in childhood. J Pediatr 92:584, 1978)
