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Splenectomy in İmmune Thrombocytopenia: A Retrospective Analysis of 25-Year Follow-up Data from a Tertiary Health Clinic


Immune thrombocytopenia (ITP) is a rare autoimmune disorder presenting with isolated thrombocytopenia. Splenectomy is still one of the treatment alternatives for these patients. Here we aim to analyze long term follow-up data of splenectomy in immune thrombocytopenia. This retrospectively designed study was conducted in a tertiary health clinic. Patients with ITP who were splenectomized between 1990 and 2015 were included. Response to treatment was interpreted as ‘complete response', ‘response' or ‘no response'. The incidence of response loss was evaluated. Perioperative and long term complications and overall survival rates were determined. Out of 51 patients, who underwent splenectomy after 12 months of diagnosis, 47 achieved a response (92.2%). Of 47 patients who had a platelet count at least 30.000/µL, 41 (87.2%) had CR. Incidence of loss of response was 10.5% (95% confidence interval (CI): 4%-26.1%) at 30 months. Two patients died, and overall survival rate was 97.4% (95% CI: 82.8%-99.6%) at 30 months of follow up. Considering the complications: two patients had venous thromboembolism, 11 had minor bleeding episodes and 15 suffered from perioperative infections. Our study suggests that splenectomy promises a high level of response with acceptable complication rates. Although less preferred recently, splenectomy should still be taken into consideration when remission is not achieved especially after 12 months of disease.

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  1. Neunert C, Terrell DR, Arnold DM, et al. (2019) American Society of Hematology 2019 guidelines for immune thrombocytopenia [published correction appears in Blood Adv. 2020 Jan 28;4(2):252]. Blood Adv.;3(23):3829–3866

  2. Rodeghiero F (2018) A critical appraisal of the evidence for the role of splenectomy in adults and children with ITP. Br J Haematol 181(2):183–195

    CAS  Article  Google Scholar 

  3. Frederiksen H, Maegbaek ML, Nørgaard M (2014) Twenty-year mortality of adult patients with primary immune thrombocytopenia: a Danish population-based cohort study. Br J Haematol 166(2):260–267

    Article  Google Scholar 

  4. Frederiksen H, Ghanima W (2017) Response of first line treatment with corticosteroids in a population-based cohort of adults with primary immune thrombocytopenia. Eur J Intern Med 37:e23–e25

    Article  Google Scholar 

  5. Palandri F, Polverelli N, Sollazzo D et al (2016) Have splenectomy rate and main outcomes of ITP changed after the introduction of new treatments? A monocentric study in the outpatient setting during 35 years. Am J Hematol 91(4):E267–E272

    CAS  Article  Google Scholar 

  6. Provan D, Arnold DM, Bussel JB et al (2019) Updated international consensus report on the investigation and management of primary immune thrombocytopenia. Blood Adv 3(22):3780–3817

    Article  Google Scholar 

  7. Neunert C, Lim W, Crowther M, Cohen A, Solberg L Jr, Crowther MA (2011) The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia. Blood 117(16):4190–4207

    CAS  Article  Google Scholar 

  8. Koylu A, Pamuk GE, Uyanik MS, Demir M, Pamuk ON (2015) Immune thrombocytopenia: epidemiological and clinical features of 216 patients in northwestern Turkey. Ann Hematol 94(3):459–466

    Article  Google Scholar 

  9. Guan Y, Wang S, Xue F et al (2017) Long-term results of splenectomy in adult chronic immune thrombocytopenia. Eur J Haematol 98(3):235–241

    Article  Google Scholar 

  10. Duperier T, Brody F, Felsher J, Walsh RM, Rosen M, Ponsky J (2004) Predictive factors for successful laparoscopic splenectomy in patients with immune thrombocytopenic purpura. Arch Surg 139(1):61–66

    Article  Google Scholar 

  11. Katkhouda N, Grant SW, Mavor E et al (2001) Predictors of response after laparoscopic splenectomy for immune thrombocytopenic purpura. Surg Endosc 15(5):484–488

    CAS  Article  Google Scholar 

  12. Supe A, Parikh M, Prabhu R, Kantharia C, Farah J (2009) Post-splenectomy response in adult patients with immune thrombocytopenic purpura. Asian J Transfus Sci 3(1):6–9.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Vianelli N, Palandri F, Polverelli N et al (2013) Splenectomy as a curative treatment for immune thrombocytopenia: a retrospective analysis of 233 patients with a minimum follow up of 10 years. Haematologica 98:875–880

    Article  Google Scholar 

  14. Andrès E, Mecili M, Fothergill H, Zimmer J, Vogel T, Maloisel F (2012) Gender-related analysis of the clinical presentation, treatment response and outcome in patients with immune thrombocytopenia. Presse Med 41(9 Pt 1):e426–e431

    Article  Google Scholar 

  15. Rijcken E, Mees ST, Bisping G et al (2014) Laparoscopic splenectomy for medically refractory immune thrombocytopenia (ITP): a retrospective cohort study on longtime response predicting factors based on consensus criteria. Int J Surg 12(12):1428–1433

    Article  Google Scholar 

  16. Liao R, Tang PY, Song JF, Qin KL, Wang X, Yan X (2018) Platelet count on preoperative day 1 predicts the long-term responses to laparoscopic splenectomy for Chinese patients with medically refractory idiopathic thrombocytopenic purpura. BMC Surg 18(1):108

    Article  Google Scholar 

  17. Nyilas Á, Paszt A, Borda B et al (2018) Predictive factors for success of laparoscopic splenectomy for ITP. JSLS. 22(4):e2018.00021

    Article  Google Scholar 

  18. Leo CA, Pravisani R, Bidinost S et al (2015) Postsplenectomy recurrence of idiopathic thrombocitopenic purpura: role of laparoscopic splenectomy in the treatment of accessory spleen. G Chir 36(4):153–157

    CAS  PubMed  PubMed Central  Google Scholar 

  19. Kojouri K, Vesely SK, Terrell DR, George JN (2004) Splenectomy for adult patients with idiopathic thrombocytopenic purpura: a systematic review to assess long-term platelet count responses, prediction of response, and surgical complications. Blood 104(9):2623–2634

    CAS  Article  Google Scholar 

  20. Mikhael J, Northridge K, Lindquist K, Kessler C, Deuson R, Danese M (2009) Short-term and long-term failure of laparoscopic splenectomy in adult immune thrombocytopenic purpura patients: a systematic review. Am J Hematol 84(11):743–748

    Article  Google Scholar 

  21. Hammond WA, Vishnu P, Rodriguez EM et al (2019) Sequence of splenectomy and rituximab for the treatment of steroid-refractory immune thrombocytopenia: Does It Matter? Mayo Clin Proc 94(11):2199–2208

    CAS  Article  Google Scholar 

  22. Khellaf M, Michel M, Quittet P et al (2011) Romiplostim safety and efficacy for immune thrombocytopenia in clinical practice: 2-year results of 72 adults in a romiplostim compassionate-use program. Blood 118(16):4338–4345

    CAS  Article  Google Scholar 

  23. Cheng G, Saleh MN, Marcher C et al (2011) Eltrombopag for management of chronic immune thrombocytopenia (RAISE): a 6-month, randomised, phase 3 study. Lancet 377(9763):393–402

    CAS  Article  Google Scholar 

  24. Bussel JB, Provan D, Shamsi T et al (2009) Effect of eltrombopag on platelet counts and bleeding during treatment of chronic idiopathic thrombocytopenic purpura: a randomised, double-blind, placebo-controlled trial. Lancet 373(9664):641–648

    CAS  Article  Google Scholar 

  25. Saleh MN, Bussel JB, Cheng G et al (2013) Safety and efficacy of eltrombopag for treatment of chronic immune thrombocytopenia: results of the long-term, open-label EXTEND study. Blood 121(3):537–545

    CAS  Article  Google Scholar 

  26. Crary SE, Buchanan GR (2009) Vascular complications after splenectomy for hematologic disorders. Blood 114(14):2861–2868

    CAS  Article  Google Scholar 

  27. Boyle S, White RH, Brunson A, Wun T (2013) Splenectomy and the incidence of venous thromboembolism and sepsis in patients with immune thrombocytopenia. Blood 121:4782–4790

    CAS  Article  Google Scholar 

  28. Thai LH, Mahe’vas M, Roudot-Thoraval F et al (2016) Long-term complications of splenectomy in adult immune thrombocytopenia. Medicine 95(48):e5098 (Baltimore)

    CAS  Article  Google Scholar 

  29. Schwartz J, Leber MD, Gillis S, Giunta A, Eldor A, Bussel JB (2003) Long term follow-up after splenectomy performed for immune thrombocytopenic purpura (ITP). Am J Hematol 72(2):94–98

    Article  Google Scholar 

  30. Cuker A, Cines DB, Neunert CE (2016) Controversies in the treatment of immune thrombocytopenia. Curr Opin Hematol 23(5):479–485

    CAS  Article  Google Scholar 

  31. Thomsen RW, Schoonen WM, Farkas DK, Riis A, Fryzek JP, Sørensen HT (2010) Risk of venous thromboembolism in splenectomized patients compared with the general population and appendectomized patients: a 10-year nationwide cohort study. J Thromb Haemost 8(6):1413–1416

    CAS  Article  Google Scholar 

  32. Ejstrud P, Kristensen B, Hansen JB, Madsen KM, Schønheyder HC, Sørensen HT (2000) Risk and patterns of bacteraemia after splenectomy: a population-based study. Scand J Infect Dis 32(5):521–525

    CAS  Article  Google Scholar 

  33. Kühne T, Blanchette V, Buchanan GR et al (2007) Intercontinental Childhood ITP Study. Group Splenectomy in children with idiopathic thrombocytopenic purpura: A prospective study of 134 children from the Intercontinental Childhood ITP Study Group. Pediatr Blood Cancer. 49(6):829–834

    Article  Google Scholar 

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Authors and Affiliations



SO: Methodology, Software, Writing- Original Draft Preparation, Validation, Writing- Reviewing and Editing. TT: Conceptualization, Methodology, Software, Writing- Original draft preparation, Validation, Writing- Reviewing and Editing, Supervision. IKA: Reviewing and Editing, Supervision. FG: Data curation. TFT: Supervision.

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Correspondence to Serdar Ozkok.

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This study was conducted according to guidelines in the Declaration of Helsinki. The study was approved from the local ethical committee. No informed consent could be obtained due to its retrospective design.

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Ozkok, S., Kaygusuz Atagunduz, I., Kara, O. et al. Splenectomy in İmmune Thrombocytopenia: A Retrospective Analysis of 25-Year Follow-up Data from a Tertiary Health Clinic. Indian J Hematol Blood Transfus 38, 516–521 (2022).

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  • Immune thrombocytopenia
  • Splenectomy
  • Corticosteroids
  • Hemorrhage