What are the International Consensus Report recommendations for the surgical treatment of 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

Surgical therapy for persistent and chronic ITP:

  • Splenectomy is associated with long-term treatment-free remissions. However, deferring splenectomy for ≥12 to 24 months from diagnosis before performing splenectomy is recommended because of the chance of remission or stabilization of the platelet count at a hemostatic level; up to one third of patients may remit in 1 year, and up to 80% may remit in 5 years. 
  • When available, indium-labeled autologous platelet scanning may be useful prior to splenectomy to confirm that the spleen is the main site of platelet sequestration.
  • Laparoscopic splenectomy is as effective as open splenectomy in terms of response and is more comfortable for the patient.
  • Postoperative thromboprophylaxis should be considered in patients undergoing splenectomy as long as the platelet count is > 30 to 50 × 10 9/L.
  • Splenectomy should be performed by a surgeon experienced in identifying accessory splenic tissue, which is common and should be removed.
  • Appropriate vaccination against  Streptococcus pneumoniaeNeisseria meningitidis, and  Haemophilus influenzae must be provided ≥2 weeks before splenectomy and maintained according to national guidelines; recent treatment (within 6 months) with rituximab may impair vaccination efficacy.
  • Patients should be informed of the long-term risks of splenectomy (ie, increased rates of thrombosis, infection, and cancer) and educated to follow advice aimed at mitigating these complications.
  • Antibiotic prophylaxis should be given as per national guidelines.

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