Splenectomy for primary immune thrombocytopenia in adults

Abstract

Patients with primary immune thrombocytopenia (ITP) may require treatment to reduce the risk of serious bleeding if platelets remain consistently below 30 G/l. While approximately 70–90% of patients respond to an initial course of corticosteroids, relapse is common. For steroid-refractory patients there is a choice between surgical splenectomy and further medical treatments. The decision whether to proceed to splenectomy or try other medical therapy remains patient-specific. Splenectomy has perioperative and long-term risks. Moreover relapse/nonresponse are relatively common but splenectomy offers the possibility of cure in the majority of patients. However newer treatments including thrombopoietin receptor agonists and rituximab may potentially allow splenectomy to be deferred for prolonged periods, as well as providing alternative treatment options for patients who fail splenectomy.