What are the International Consensus Report recommendations for splenectomy to treat children with immune thrombocytopenia (ITP)?

Updated: Jan 11, 2020
  • Author: Craig M Kessler, MD, MACP; Chief Editor: Srikanth Nagalla, MBBS, MS, FACP  more...
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Answer

Splenectomy:

  • Splenectomy is very rarely indicated in childhood ITP, and should be undertaken in consultation with a hematologist experienced in the management of children with ITP. It should only be considered in children who have failed all available medical therapies, are having thrombocytopenia-related bleeding, and whose life is at risk or whose HRQoL is substantially impaired.
  • Splenectomy should be avoided if at all possible before 5 years of age and within 1 year of disease onset.
  • Before considering splenectomy, reassess the diagnosis of ITP by excluding alternative diagnoses, including inherited thrombocytopenia, bone marrow failure, drug-induced thrombocytopenia, subclinical viral infections, immunodeficiency syndromes (eg, common variable immune deficiency [CVID], autoimmune lymphoproliferative syndrome), and myelodysplastic syndrome.
  • Prior to splenectomy, ensure that vaccinations are up to date according to national policy. Vaccination, as a minimum, should include pneumococcal 13-valent conjugate vaccine, followed by pneumococcal 23-valent vaccine 4 weeks later; H influenzae type B; and both meningococcal vaccines to cover all 5 species subtypes.
  • If there is any concern for an immunodeficiency-related ITP, even if undocumented, reducing the risk for postsplenectomy sepsis by assessing response to pneumococcal vaccines preprocedure is advisable.

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