Idiopathic thrombocytopenic purpura is an autoimmune disorder characterized by thrombocytopenia caused by antiplatelet autoantibodies bind to platelets membrane antigens. Corticosteroids represent the first-line treatment and in case of their failure, splenectomy leads to remissions in 60% to 70% of patients. A little data are available on early postoperative course and long-term follow-up in selected group of patients with severe thrombocytopenia prior to splenectomy. Two weeks after splenectomy and during still ongoing immunosuppressive therapy, in a group of 11 corticosteroid- resistant patients with the median number of 4 (0–15) x 109/l thrombocytes just prior to splenectomy, there were 3/11 (27%) patients with no treatment response, in 5/11 (56%) patients early increased thrombocytes fell down again bellow 30x109/l and only in 3/11 (27 %) the number of thrombocytes permanently grew over 30x109/l. With the median follow-up of 50 (0,7–73) months and concurrent immunosuppressive treatment given during the median of 8 (0,7–67) months, one patient with refractory ITP died of bleeding on day 22 post splenectomy, one patient remains therapy resistant and stabile remission was reached in 9/11 (82 %) patients (5/11, 45 % complete remission). Median time from splenectomy to the best therapy-response was 1 (0–27) months and the patients have stayed in remission for 59 (18–70) months, so far. ITP relapsed in 3/9 (33 %) patients after median remission-duration of 32 (31–60) months. In patients with severe thrombocytopenia there were more bleeding complications after splenectomy. Probability of the splenectomy failure, several-weeks lasting severe thrombocytopenia or long-time immunosuppressive treatment necessary to reach stabile remission, must be always considered on splenectomy indication.

        Key words: idiopathic thrombocytopenic purpura, splenectomy, immunosuppression, complications