Splenectomy

Abstract

In immune thrombocytopenic purpura (ITP) patients, an interaction between T cells and B cells induces antiplatelet autoantibody production, and macrophages digest the antibody-platelet complex in the spleen. However, splenectomy removes the microenvironment important for the interaction among B cells, T cells, macrophages, and opsonized platelets. Moreover, splenectomy leads to a high frequency of durable responses in adult patients with ITP. Perioperative complications of splenectomy include bleeding, infection, and thrombosis. Additionally, long-term complications include overwhelming sepsis by encapsulated bacteria, vascular/ thrombotic events, and cancer. Recent guidelines and expert consensus reports list splenectomy as a second-line therapy for patients who have failed corticosteroid therapy. More recently, there has been a tendency to avoid and defer splenectomy in favor of new treatment options, resulting in a decrease in the use of splenectomy for ITP.