Abstract Number: PB1357
Meeting: ISTH 2020 Congress
Theme: Platelet Disorders and von Willebrand Disease » Acquired Thrombocytopenias
Background: Splenectomy has always been considered a very efficacious surgical second line therapy for chronic primary Immune Thrombocytopenia (pITP), although bleedings, infections and thromboses can occur as short- and long-term complications. In light of the introduction of rituximab and TPO-receptor agonists, clinicians have reduced the use of splenectomy.
Aims: To evaluate splenectomy long-term complications in a large pITP cohort and to investigate their impact on this therapeutic choice in this era.
Methods: Patients were followed in our Center between 1955 and 2018. Data related to demographics, treatments, infections, thromboses and neoplasms were collected in a Microsoft Excel File and then processed with SPSS software.
Results: We enrolled 164 splenectomized patients and 1503 controls. Patients characteristics are showed in table 1. Among controls, 896 underwent at least 1 therapy line, 607 were only observed. Infections prevalence was significantly higher in splenectomized patients vs the whole control cohort (29.87% vs 10.84%; p 0.001) an the treated and observed subgroups (29.87% vs 12.95% or vs 7.74%; p 0.001) (table 2). Prevalence of thromboses was significantly higher in splenectomized cases compared to observed ones (5.4% vs 1.97%, p 0.015), while was not significant when compared to the whole control cohort or to treated patients (p 0.154 and p 0.412, respectively). Rate of neoplasms was significantly higher in splenectomized patients compared to observed cases (7.32% vs 2.96%, p 0.010) while was not significative compared to the whole control cohort or with treated patients (p 0.194 and 0.654, respectively).
Conclusions: Splenectomy presents a higher risk of infections. The rate of thromboses and neoplasms is not statistically different comparing splenectomized patients with treated ones, suggesting a role for medical therapies in such complications. Splenectomy still has a role in the therapeutic course of chronic ITP patients, but it is necessary a very good infections prophylaxis and monitoring.
| Splenectomized (n.164) | Non splenectomized (n. 1503) | |
| Sex | M = 45; F = 119 | M = 534; F = 969 |
| Median age at diagnosis, years | 24 (2 – 64) | 43 (0.5 – 93) |
| Median time between diagnosis and splenectomy, months | 26.5 (0 – 312) | NA |
| Therapies | Before splenectomy 0 lines = 3 (1.83%); 1 line = 86 (52.44%); 2 lines = 46 (28.01); 3 lines = 20 (12.2%); more than 3 lines = 7 (4.3%); missed data = 2 (1.22%). | yes = 896; no =607. 1 line = 586 (65.40%); 2 lines = 199 (22.20%); 3 lines = 74 (8.20%); more than 3 lines = 40 (4.20%) |
| Post – splenectomy (57 relapsed patients) 0 lines = 3 (5.26%); 1 line = 29 (50.9%); 2 lines = 11 (19.3%); 3 lines = 8 (14.04%); more than 3 lines = 6 (10.5%). |
[Table 1]
| Infections | No infections | Total | |
| Splenectomized | 49 (29.87%) | 115 (70.13%) | 164 |
| Treated, not splenectomized | 116 (12.95%) | 780 (87.05%) | 896 |
| Observed | 47 (7.74%) | 560 (92.26%) | 607 |
[Table 2]
To cite this abstract in AMA style:
Marcosano M, Ferretti A, Baldacci E, Paoloni F, Aprile S, Chistolini A, Serrao A, Mazzucconi MG, Santoro C. Long Term Complications after Splenectomy in Chronic pITP Patients: A Retrospective Case Control Study [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/long-term-complications-after-splenectomy-in-chronic-pitp-patients-a-retrospective-case-control-study/. Accessed November 26, 2021.« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/long-term-complications-after-splenectomy-in-chronic-pitp-patients-a-retrospective-case-control-study/