Our Summary

The research paper discusses a case of a woman with immune thrombocytopenic purpura (ITP), a condition where the body’s immune system destroys its own platelets, leading to a low platelet count and increased bleeding. The woman initially received a treatment called a splenectomy, where doctors removed her spleen to try to increase her platelet count. However, seven years later, her ITP symptoms returned. Doctors found an extra (accessory) spleen, which they also removed. Unfortunately, even after both spleen removals, the woman continued to have ITP symptoms, suggesting that removing the spleen may not always be an effective treatment for this condition. The woman eventually passed away. The authors suggest that in some cases, other treatments like bone marrow transplants may be necessary.

FAQs

  1. What is a splenectomy and why is it used as a treatment for immune thrombocytopenic purpura (ITP)?
  2. What other treatments are suggested for ITP if a splenectomy is not effective?
  3. Can ITP symptoms return after a splenectomy and what might be the cause of this?

Doctor’s Tip

One helpful tip a doctor might tell a patient about splenectomy is to be aware that while it can be an effective treatment for certain conditions like ITP, it may not always provide a permanent solution. It is important to discuss with your healthcare provider about long-term management and potential alternative treatments if needed. Additionally, maintaining regular follow-up appointments and monitoring your health closely after a splenectomy is crucial to ensure proper care and management of any potential complications.

Suitable For

Patients with certain conditions may be recommended for splenectomy, including:

  1. Immune thrombocytopenic purpura (ITP): Patients with ITP may be recommended for splenectomy if other treatments, such as medications or steroids, have not been effective in increasing platelet counts.

  2. Hereditary spherocytosis: This is a condition where red blood cells are abnormally shaped and destroyed by the spleen. Splenectomy may be recommended to alleviate symptoms and prevent complications.

  3. Thalassemia: In some cases of thalassemia, splenectomy may be recommended to manage complications such as an enlarged spleen or low blood cell counts.

  4. Sickle cell disease: Patients with sickle cell disease may be recommended for splenectomy if they experience complications such as splenic sequestration crises or if the spleen becomes enlarged and painful.

  5. Lymphoma: In some cases of lymphoma, splenectomy may be recommended to remove cancerous cells from the spleen and improve overall treatment outcomes.

It is important for patients to discuss the potential risks and benefits of splenectomy with their healthcare provider and to explore other treatment options that may be available.

Timeline

  • Before splenectomy: The patient likely experiences symptoms of ITP, such as easy bruising, nosebleeds, and excessive bleeding. They may have tried other treatments, such as corticosteroids or immunosuppressive drugs, without success.

  • Splenectomy: The patient undergoes surgery to remove their spleen in an attempt to increase their platelet count and improve their symptoms. The surgery is usually successful in increasing platelet counts in the short term.

  • After splenectomy: The patient may experience improvements in their symptoms initially, as their platelet count increases. However, in some cases, like the woman in the research paper, ITP symptoms can return years later. This could be due to factors such as the presence of an accessory spleen or the immune system continuing to target platelets.

  • Additional treatment: If ITP symptoms return after splenectomy, the patient may require further treatments, such as medications, blood transfusions, or other surgical interventions. In some cases, more aggressive treatments like bone marrow transplants may be necessary to manage the condition.

  • Ultimately, the outcome of splenectomy for ITP can vary from patient to patient, and it may not always provide a long-term solution for the disease. It is important for patients to work closely with their healthcare providers to determine the most appropriate treatment plan for their individual case.

What to Ask Your Doctor

  1. What are the potential risks and benefits of a splenectomy for treating ITP?
  2. Are there alternative treatment options for ITP that should be considered before opting for a splenectomy?
  3. What is the likelihood of ITP symptoms returning after a splenectomy?
  4. How will a splenectomy impact my immune system and overall health in the long term?
  5. Are there any specific factors or conditions that may make me a poor candidate for a splenectomy?
  6. What follow-up care and monitoring will be necessary after a splenectomy?
  7. If I do not respond well to a splenectomy, what other treatment options are available for managing my ITP?
  8. What is the role of an accessory spleen in ITP, and how common is it for this to be a factor in recurring symptoms?
  9. Will removing an accessory spleen improve my ITP symptoms, or are there other factors that may need to be addressed?
  10. What is the prognosis for ITP patients who undergo a splenectomy, and what are the potential long-term outcomes to consider?

Reference

Authors: Riaz A, Ali HT, Ali F, Ali J. Journal: Clin Hemorheol Microcirc. 2023;85(2):189-194. doi: 10.3233/CH-231881. PMID: 37599530