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Long Term Complications after Splenectomy in Chronic pITP Patients: A Retrospective Case Control Study

M. Marcosano1, A. Ferretti1, E. Baldacci1, F. Paoloni2, S. Aprile1, A. Chistolini1, A. Serrao1, M.G. Mazzucconi1, C. Santoro1

1Sapienza University of Rome, Hematology, Policlinico Umberto I, Department of Translational and Precision Medicine, Rome, Italy, 2Data Center-GIMEMA Foundation - Franco Mandelli ONLUS, Rome, Italy

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 October 1, 2023.

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