Splenectomy for Acute or Persistent Immune Thrombocytopenia: an Overkill or a Necessity

Splenectomy is usually deferred for the first 12 months of onset of immune thrombocytopenia (ITP) because patients may have spontaneous remission. However, in patients with failed medical management, splenectomy is a valuable treatment option. This study aimed to evaluate the role of splenectomy in patients with persistent ITP with failed medical management at a tertiary care center. A retrospective review of records of all patients who underwent splenectomy for ITP between January 2010 and December 2019 was done. We identified the patients with primary ITP refractory to medical management who were referred from hematology to our department for splenectomy and their clinical course was evaluated. Most of the patients were females (14/20, 70%), and the mean age of patients in our series was 33.7 +/- 11.1 years. Skin petechiae and mucosal bleeding were the most common presenting symptoms. Mean pre-operative platelet count was 20,079 +/- 11,644/mu L. After a trial of medical management for a mean duration of 6.7 +/- 3.6 months, patients were planned for splenectomy. All patients improved symptomatically after surgery. A significant increase in platelet count was observed (mean: 80,290 +/- 75,327/mu L). Splenectomy (either open or laparoscopic approach) is a safe and very good option in patients with new onset and persistent ITP refractory to medical management with favorable outcomes.