Splenectomy in Primary Immune Thrombocytopenia (ITP)

Splenectomy in Primary Immune Thrombocytopenia(ITP)

Splenectomy represents an effective second-line therapy for the treatment of primary immune thrombocytopenia (ITP). The objective of surgery is to stop the bleedings by eliminating the organ responsible for the clearance of antibody-coated platelets. We evaluate the efficacy of laparoscopic splenectomy versus open splenectomy for primary immune thrombocytopenia in patients with severe refractory thrombocytopenia. We studied 56 patients with ITP hospitalized in the Clinic of Hematology from Craiova (Romania) between 2003-2012. All patients were diagnosed with ITP, other causes of thrombocytopenia having been ruled out. All patients were initially treated with corticosteroids ± immunoglobulins as first line therapy and vinca allkaloids and splenectomy as secondline therapy. Indications for splenectomy were bleedings and low platelet count (<30×109/l) after corticosteroids/immunoglobulin/ vincristine. Eleven patients from 56 had indications for splenectomy: Three patients received open splenectomy and eight laparoscopic splenectomy. Seven patients obtained a very good response after splenectomy, three patients obtained a good response and one no response after splenectomy. After three years from splenectomy, two patients relapsed (one due to accessory spleen). In conclusion, in our small cohort of patients, laparoscopic splenectomy seemed preferable to open splenectomy, reducing the level of patients discomfort, the postsurgical complications and the hospitalization period.