When is splenectomy indicated in the treatment of chronic immune thrombocytopenic purpura (ITP) platelet disorder in adults?

Updated: Aug 05, 2017
  • Author: Perumal Thiagarajan, MD; Chief Editor: Srikanth Nagalla, MBBS, MS, FACP  more...
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Answer

Answer

The second line of treatment for the management of steroid failures is splenectomy. Splenectomy is considered for any patient who does not respond to steroids (or who cannot receive steroids) and has clinically significant bleeding manifestations. [20]

The appropriate time to perform the splenectomy is controversial. Most physicians wait for 3-6 months before recommending splenectomy because sometimes ITP goes into spontaneous remission, especially in younger patients. Often, other clinical considerations (eg, coexistence of diabetes or peptic ulcer disease [PUD]) may influence the decision for earlier splenectomy.

Splenectomy is effective because it removes the major site of destruction and the major source of antiplatelet antibody synthesis. Even if complete remission is not achieved, the platelet count will be higher after splenectomy. [21] Before splenectomy, patients should receive a pneumococcal vaccine.

 

Approximately 10-20% of patients who undergo splenectomy remain thrombocytopenic and continue to have a bleeding risk that requires continued treatment. Both steroid therapy and splenectomy are considered to have failed in these patients, and the patients are challenging to treat. An accessory spleen should be excluded as the cause of treatment failure after splenectomy. [21]


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