Splenectomy

Why remove the spleen?
In people with ITP the immune system treats platelets as foreign and destroys them. The spleen is responsible for removing these damaged platelets and therefore removal of the spleen can help to keep more platelets circulating in the body. Splenectomy used to be the standard treatment for ITP before drug therapies were developed, and it is still carried out in patients with chronic severe ITP (troublesome ITP for a year or more). In the UK leading ITP specialists only carry out splenectomy when all other options have been exhausted, and it has been preceded by an indium labelled platelet spleen scan (performed in the nuclear medicine department of certain hospitals) to investigate whether the platelets are being destroyed in the spleen. If this test shows that platelets are mainly being destroyed elsewhere in the immune system a splenectomy is unlikely to raise the platelet count.

How is the spleen removed
Splenectomy is often carried out as a laparoscopic procedure (keyhole surgery) which has the advantage of a shorter hospital stay and quicker recovery time. However, in some patients the surgeon may need to revert to open surgery if the spleen is particularly large or there are other complications.

What are the risks
There is an increased risk of infection after splenectomy and any fever or infection should receive urgent medical treatment. Vaccinations against hepatitis B, pneumococcal infections, meningitis and hæmophilus influenzæ,will be given before the splenectomy is carried out, or immediately afterwards in the case of an emergency splenectomy. Asplenics (people without a spleen) in the UK are advised by the Department of Health to take antibiotics for life, but in many other countries a standby dose of antibiotics is issued to carry at all times and take at the first sign of infection.

What about children
Children rarely have a splenectomy unless their ITP is particularly troublesome, as most recover from ITP, and the risk of infection without a spleen is far higher until the immune system becomes fully developed in teenage years.

Further reading: The ITP Support Association produces a booklet ITP & Splenectomy giving further information on all aspects of splenectomy, and a leaflet written by Prof Newland entitled 'Is Splenectomy in ITP still a valid treatment option today?' These are available free of charge to members.

See this link for further information by the Health Protection Agency on minimising the risks of infection in people without a spleen.