Background: Splenectomy is indicated for second line therapy in refractory immune thrombocytopenic purpura (ITP). Risk of infection, thrombosis, pulmonary hypertension and immediate post splenectomy complication may have contributed to the decreased in splenectomy rates.

Aims: To describe the outcome of splenectomy in patients with refractory ITP in a tertiary centre.

Methods: Data was obtained from patients’ medical record and database at Ampang Hospital, Malaysia. Adult patients with refractory ITP who underwent splenectomy between January 2009 until December 2019 were included. Demographics, clinical characteristics and treatment outcomes were collected and analyzed using descriptive statistics.

Results: Approximately 2.5% (n=12) from total adult ITP cases (n=487) underwent splenectomy within the study period. Mean age at diagnosis was 29.7 ± 17.0 years old. Mean platelet count was 13.4 ± 11.5 (range 3 – 44) x 10⁹/L with 41.7% had intracranial bleeding at presentation. Most of the cases failed at least two line medical therapy; eight cases (66.7%) were treated with Rituximab and half of them received Eltrombopag prior splenectomy. Sixty seven percent (n=8) achieved complete remission and 16.7% (n=2) had partial response after splenectomy with median follow up of 44 months (range 1-108). Among the responders, one case relapsed after 24 months post splenectomy. All of the cases had laparoscopic splenectomy except one who needed open splenectomy due to intraoperative bleeding. Four patients had acute complication (2 cases had infection, 2 cases had thrombocytosis) after surgery.

Conclusions: Although surgical risks are important, splenectomy provides long-term benefit for patients who did not achieved durable remissions with glucocorticoid treatment. Our series suggest that splenectomy offers disease remission in 80% of cases with no mortality reported, although there were five patients who had non-fatal complications.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/outcome-of-splenectomy-in-adult-refractory-immune-thrombocytopenic-purpura-a-descriptive-analysis/