EFFICACY OF SPLENECTOMY IN PRIMARY IMMUNE THROMBOCYTOPENIA

Introduction. Immune thrombocytopenia (ITP) is an a utoimmune disorder characterized by isolated thrombocytopenia. Splenectomy is one the most effective treatment methods for this disorder. Aim - to evaluate the efficacy and safety of a splenectomy in patients with primary immune thrombocytopenia. Subjects and methods. 111 patients (31 males, 80 females) with primary immune thrombocytopenia who were hospitalized to perform laparoscopic splenectomy were included in a prospective study conducted at the National Research Center for Hematology from 2015 to 2019. Disease duration from onset to splenectomy was from 1 month to 51 years. Response to the splenectomy, complications, and correlation with immediate preoperative platelet count were analyzed. Results. Complete response was achieved in 79 (71.2 %) cases, a partial response was achieved in 11 (9.9 %) cases, and in 21 (18.9 %) cases there was no response. Immediate preoperative platelet count was significantly higher in patients with complete response in comparison with the group with no response, median (95% CI): 47 (35-58) vs 16 (9-20), p < 0.001. Multivariate analysis (logistic regression) was performed. According to this regression, a risk factor for an unfavorable response was detected - males > 60 years of age, p = 0.05; RR (95% CI): 2.0 (0.9-7.1). A predictor of unfavorable response was identified - immediate preoperative platelet count < 23 x 10(9)/l (cutoff point determined in ROC-analysis); p = 0.001, RR (95% CI): 2.5 (1.1-8.6). The probability of complete response was lower with the number of treatment lines prior to splenectomy (weak inverse correlation: r(s) = -0.30; p = 0.01). The frequency of postoperative complications was 12.6 %. According to our follow-up data, a complete response was preserved in 66/79 (83.5 %) of patients, with a follow-up of 2.7 years. Conclusion. Splenectomy is an effective and safe treatment method for ITP. Factors of unfavorable response were identified: males > 60 years of age and immediate preoperative platelet count < 23 x 10(9)/l. It is safe to perform splenectomy regardless of effectiveness of preoperative splenectomy treatment and platelet count.