Idiopathic thrombocytopenic purpura surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Surgery

Splenectomy

Splenectomy offers a 2nd line treatment for those who fail steroids. The criteria for surgery are severe thrombocytopenia (<10,000), high risk of bleeding or the requirement of frequent steroids/IVIgG/anti-D treatment to maintain an adequate platelet count. Of the ~15% of children with persistent thrombocytopenia bleeding symptoms are uncommon and splenectomy is rarely required. However splenectomy is an effective treatment option for children with severe / symptomatic thrombocytopenia with a CR of ~75%. Because of the risk for overwhelming sepsis after splenectomy it should be deferred until after 5 years of age. Remember to give immunizations before splenectomy and perioperative antibiotics. Response to IV-IgG often predicts a response to splenectomy (increasing the platelet count to >50,000 with IgG means a >90% RR to splenectomy).[1]

Splenectomy is safe and effective in ~80% of patients with refractory HIV-related thrombocytopenia and treated with interferon (IFN) may be effective in refractory cases of patients coinfected with HCV. A decrease in platelets in HIV can arise secondary to both HCV and hepatitis B (HBV).[2]

References

  1. Ghanima W, Godeau B, Cines DB, Bussel JB (August 2012). "How I treat immune thrombocytopenia: the choice between splenectomy or a medical therapy as a second-line treatment". Blood. 120 (5): 960–9. doi:10.1182/blood-2011-12-309153. PMID 22740443.
  2. Schifferli A, Kühne T (January 2013). "Chronic immune thrombocytopenia in children: who needs splenectomy?". Semin. Hematol. 50 Suppl 1: S58–62. doi:10.1053/j.seminhematol.2013.03.010. PMID 23664519.

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