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Splenectomy in Idiopathic Thrombocytopenic Purpura: Its Correlation with the Sequestration of Autologous Indium-111-Labeled Platelets

Department of Hematology, Hopital Pontchaillou, Rennes, France
Departments of Nuclear Medicine and Hematology, Centre Eugène Marguis, Rennes, France
Department of Hematology, Hospital of St-Brieuc, France

Correspondence: For correspondence or reprints contact: T. Lamy, Dept. of Hematology, Hopital Pontchaillou, Rennes, France.

ABSTRACT

We present a retrospective analysis of ¹¹¹In-platelet sequestration studies in 111 patients with the clinical diagnosis of idiopathic thrombocytopenic purpura (ITP). Fifty-one of these patients underwent splenectomy, independent of the results of the ¹¹¹In-platelet studies to determine if these isotopic results could accurately predict a beneficial response to splenectomy. Between January 1984 and June 1990, 111 patients who presented with ITP were subjected to a study of autologous ¹¹¹In-labeled platelets through autotransfusion. The platelet sequestration site was splenic (81%), mixed (12%), or hepatic (7%). Fifty-one patients with persistent drug-resistant thrombocytopenia underwent splenectomy regardless of the isotopic results: 33 patients beyond 6 mo after diagnosis and 18 with high hemorrhagic risks before this delay. The follow-up median duration was 2.9 yr. Thirty-three of the 38 patients with splenic sequestration showed a normalized platelet count, as opposed to 2 of the 13 with mixed or hepatic sequestration (p < 0.001). In addition, platelet survival extended beyond 8 days in six patients, with no apparent sequestration site. The platelet isotopic study performed with this technique appears to be indicated in ITP: it guides clinicians in their decision to perform splenectomy and relates to a more central mechanism certain thrombocytopenias that are inappropriately categorized as ITP.

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