A 40-year old woman with chronic immune thrombocytopenic purpura (ITP) is refractory to corticosteroids. The approximate likelihood she will benefit from a splenectomy is approximately which of the following?

c. 60%

Splenectomy remains the principal treatment for ITP. Platelet counts rise to adequate levels in 60% to 80% of patients who undergo the procedure. Ninety percent of patients who have had good responses to corticosteroids have improved platelet counts after splenectomy. Of patients who do not respond to corticosteroids, about 60% respond to splenectomy. Splenectomy is effective by virtue of its ability to remove the site of platelet destruction. Because the spleen is the site of most platelet sequestration in ITP, splenectomy should eliminate this source of platelet consumption. Furthermore, splenectomy removes a significant source of antiplatelet IgG production.