Abstract Number: PB0889
Meeting: ISTH 2021 Congress
Theme: Platelet Disorders, von Willebrand Disease and Thrombotic Microangiopathies » Platelet Function Disorders, Acquired
Background: Immune thrombocytopenia (ITP) is a benign bleeding disease characterized by immune-mediated increased platelet destruction and/or thrombocytopenia. life-threatening bleeding (e.g., intracranial, gastrointestinal, and severe hemoptysis) can lead to serious complications and even death in ITP patients. Emergency Splenectomy treatment is available for these patients failure to respond to other medications.
Aims: To emphasize the importance of emergency splenectomy for immune thrombocytopenia patients with life-threatening bleeding.
Methods: We report the case details of three patients who had acute lethal hemorrhage of ITP:
case 1 (165/ male) severe hemoptysis;
case 2 (33/ female) and
case 3 (13/ female) intracranial hemorrhage.
The patient in Case 1 with chronic ITP improved hemoptysis after bronchial artery embolization and his platelet count recovered 2 days after splenectomy. But he went on to develop antiphospholipid syndrome at 5 months after operation.
Case 2 the patient underwent urgent emergency splenectomy due to left temporal lobe hemorrhage and recovered platelet count one day after surgery. But she was diagnosed secondary epilepsy after hemorrhage. One month after the operation, She returned to hospital for rituximab (375 mg/m2×4 weekly) treatment with thrombocytopenia and menorrhagia. She remained complete response (CR) during a two-year follow-up. Case 3 a girl underwent emergency splenectomy for intracerebral hemorrhage, and suffered a cardiopulmonary arrest shortly subsequently. Eventually, she died for increased intracranial hemorrhage.
Results: In our cases, except case 3, other patients successful performed emergency splenectomy and recovered the platelet count.
Conclusions: In literature, reports of ITP responding to emergency splenectomy in patients with life-threatening bleeding have been reported, but the peculiarity of our cases are that platelet count recovery has been obtained with emergency splenectomy in adult and the relapsed patient can benefit from rituximab after operation. However, the choice in children patient should be more cautious.
Platelet count recovery after start of emergency splenectomy
To cite this abstract in AMA style:
Yang M, Zhou Z. Emergency Splenectomy for Immune Thrombocytopenia (ITP) Patients with Life-threatening Bleeding: A Report of Three Cases and Review of the Literature [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/emergency-splenectomy-for-immune-thrombocytopenia-itp-patients-with-life-threatening-bleeding-a-report-of-three-cases-and-review-of-the-literature/. Accessed December 7, 2021.« Back to ISTH 2021 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/emergency-splenectomy-for-immune-thrombocytopenia-itp-patients-with-life-threatening-bleeding-a-report-of-three-cases-and-review-of-the-literature/