Outcomes of splenectomy in adult primary immune thrombocytopenia: a 20-year retrospective study

Outcomes of splenectomy in adult primary immune thrombocytopenia: a 20-year retrospective studyAuthors: N. Ould Kablia, M.C. Rahali, B. Ouadah, S. Baghdad, S.E. Belakehal, F.Z. ArdjounAbstractPrimary immune thrombocytopenia (ITP) is an autoimmune disorder characterized by isolated thrombocytopenia caused by immune-mediated peripheral platelet destruction. The diagnosis is established after exclusion of secondary causes such as drug exposure, toxins, infections, or systemic diseases. Corticosteroids remain the standard first-line therapy. In patients with persistent or refractory disease beyond six months, splenectomy is considered as a second-line treatment aimed at removing the principal site of antiplatelet antibody production and platelet sequestration.We conducted a retrospective study over a 20-year period in the Hematology Department of HCA Hospital. Among 189 patients diagnosed with ITP (87 men and 102 women; sex ratio 0.85; mean age 35 years, range 1–90), all initially received corticosteroid therapy. Splenectomy was performed in 48 patients (25%) after a mean interval of 30 months from diagnosis. Platelet kinetic studies were performed in 9 patients (18%), revealing mixed hepato-splenic sequestration in one case and isolated splenic sequestration in eight cases. All patients received prophylactic measures including pneumococcal vaccination prior to surgery.No postoperative mortality was observed. Perioperative complications included two cases of intraoperative hemorrhage and four cases of postoperative sepsis, including one subphrenic abscess requiring surgical reintervention. A complete response (platelet count >150,000/mm³) was achieved in 34 patients (71%). Among responders, relapse occurred in 17 patients (50%), while 14 patients (29%) were considered treatment failures.These findings confirm that splenectomy remains an effective therapeutic option in adult ITP, with a high initial response rate and acceptable procedural risk when appropriate prophylactic measures are implemented.KeywordsPrimary immune thrombocytopenia; Splenectomy; Autoimmune thrombocytopenia; Platelet kinetics; Hematology; Retrospective study