Splenectomy seems to be safe and efficient in the long term for the treatment of children with immune thrombocytopenia (ITP), making it a viable treatment option even though new therapeutic agents exist, according to a new study published in the International Journal of Hematology.

However, the authors of the study noted that the number of cases is small and more research is needed to compare the safety and efficacy of splenectomy with that of the new agents in treating pediatric ITP, the authors noted.

Read more about the pathophysiology of ITP

The data presented here comes from splenectomies performed on 23 patients with ITP at a single institution in Japan. 

It shows that splenectomy was highly efficient and led to a partial response rate of 83% and a complete response rate of 74%. The majority of patients (70%) maintained a complete response to the treatment and 91% discontinued long-term medical treatment. There were also no reports of serious complications like infections.

“Splenectomy for pediatric [chronic] ITP is highly effective and can be safely performed in Japan,” the researchers concluded. “ Under proper perioperative management, splenectomy is still considered an effective and safe treatment option.”

ITP is an autoimmune disorder characterized by very low platelet counts. It is caused by the immune system mistakenly attacking antigens on the surface of platelets. 

The spleen is the primary site of ITP pathogenesis due to the fact that autoantibodies against platelets as well as the mononuclear macrophages that destroy the autoantibody-covered platelets form in the sleep.

Splenectomy or the complete removal of the spleen is not favored by some practitioners due to the risk of infections and sepsis following the surgery. Medical treatments for the disease include rituximab and thrombopoietin receptor agonists. However, their discontinuation is associated with symptom recurrence.

Reference

Isshiki K, Mori M, Irikura T, et al. Long-term efficacy and safety profile of splenectomy for pediatric chronic immune thrombocytopenia. Int J Hematol. Published online January 9, 2023. doi:10.1007/s12185-022-03529-z