Is splenectomy an effective management for chronic ITP?

Question

Hello doctor,

I am a 41-year-old woman who was diagnosed with chronic ITP three years ago after experiencing frequent bruises and gum bleeding. My platelet count usually stays between 25,000 to 40,000. I also have hypothyroidism and take Levothyroxine. I previously tried steroids, which improved my counts, but they relapsed after tapering. I am currently on eltrombopag. My latest labs show platelets at 38,000, with normal hemoglobin and WBC. I am concerned about the risk of bleeding and the potential effects of the drug on my liver. Is splenectomy still considered a treatment option for ITP nowadays?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

So, your history of chronic immune thrombocytopenia (ITP) for three years, with persistent low platelet counts despite steroids and current treatment with eltrombopag, fits the pattern of refractory or chronic ITP.

Eltrombopag is effective for raising platelet counts and reducing bleeding risk, but it does require monitoring of liver function because hepatotoxicity can occur.

Splenectomy is still considered in ITP today, particularly for patients who do not respond adequately to medical therapy or cannot tolerate long-term medications, though it is usually deferred until after trying less invasive treatments.

The procedure can provide long-term remission in many cases, but it carries surgical risks and a lifelong small risk of infections. For your platelet level around 38,000, the spontaneous bleeding risk is generally moderate, but caution is advised with trauma or invasive procedures, and any sudden drop or symptoms like gum bleeding, nosebleeds, or bruising should prompt urgent evaluation.

Ongoing monitoring of platelet counts, liver function, and general health is important while on eltrombopag, and discussions with your hematologist can help decide if splenectomy or other second-line therapies are appropriate based on response and lifestyle considerations.

I hope this helps.

Kindly follow up if you have more concerns.

Thank you.