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.
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Olsson B, Ridell B, Jernås M, Wadenvik H. Increased number of B-cells in the red pulp of the spleen in ITP. Ann Hematol. 2012;91(2):271–7.
Stasi R. Immune thrombocytopenia: pathophysiologic and clinical update. Semin Thromb Hemost. 2012;38(5):454–62.
Borges da Silva H, Fonseca R, Pereira RM, Cassado Ados A, Álvarez JM, D'Império Lima MR. Splenic macrophage subsets and their function during blood-borne infections. Front Immunol. 2015;6:480.
Kuwana M, Okazaki Y, Ikeda Y. Splenic macrophages maintain the anti-platelet autoimmune response via uptake of opsonized platelets in patients with immune thrombocytopenic purpura. J Thromb Haemost. 2009;7(2):322–9.
Yoshida Y. Historical review. The light and shadow of Paul Kaznelson: his life and contribution to hematology. Ann Hematol. 2008;87(11):877–9.
Dolan JP, Sheppard BC, DeLoughery TG. Splenectomy for immune thrombocytopenic purpura: surgery for the 21st century. Am J Hematol. 2008;83(2):93–6.
Winslow ER, Brunt LM. Perioperative outcomes of laparoscopic versus open splenectomy: a meta-analysis with an emphasis on complications. Surgery 2003;134(4):647–653; discussion 654–5.
Rodeghiero F, Ruggeri M. Is splenectomy still the gold standard for the treatment of chronic ITP? Am J Hematol. 2008;83(2):91.
Boyle S, White RH, Brunson A, Wun T. Splenectomy and the incidence of venous thromboembolism and sepsis in patients with immune thrombocytopenia. Blood. 2013;121(23):4782–90.
Kojouri K, Vesely SK, Terrell DR, George JN. Splenectomy for adult patients with idiopathic thrombocytopenic purpura: a systematic review to assess long-term platelet count responses, prediction of response, and surgical complications. Blood. 2004;104(9):2623–34.
Sailer T, Lechner K, Panzer S, Kyrle PA, Pabinger I. The course of severe autoimmune thrombocytopenia in patients not undergoing splenectomy. Haematologica. 2006;91(8):1041–5.
Provan D, Stasi R, Newland AC, Blanchette VS, Bolton-Maggs P, Bussel JB, Chong BH, Cines DB, Gernsheimer TB, Godeau B, Grainger J, Greer I, Hunt BJ, Imbach PA, Lyons G, McMillan R, Rodeghiero F, Sanz MA, Tarantino M, Watson S, Young J, Kuter DJ. International consensus report on the investigation and management of primary immune thrombocytopenia. Blood. 2010;115(2):168–86.
Neunert C, Lim W, Crowther M, Cohen A, Solberg Jr L, Crowther MA, American Society of Hematology. The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia. Blood. 2011;117(16):4190–207.
Vianelli N, Palandri F, Polverelli N, et al. Splenectomy as a curative treatment for immune thrombocytopenia: a retrospective analysis of 233 patients with a minimum follow up of 10 years. Haematologica. 2013;98(6):875–80.
Aleem A. Durability and factors associated with long term response after splenectomy for primary immune thrombocytopenia (ITP) and outcome of relapsed or refractory patients. Platelets. 2011;22(1):1–7.
Mikhael J, Northridge K, Lindquist K, Kessler C, Deuson R, Danese M. Short-term and long-term failure of laparoscopic splenectomy in adult immune thrombocytopenic purpura patients: a systematic review. Am J Hematol. 2009;84(11):743–8.
Keidar A, Feldman M, Szold A. Analysis of outcome of laparoscopic splenectomy for idiopathic thrombocytopenic purpura by platelet count. Am J Hematol. 2005;80(2):95–100.
Yong M, Thomsen RW, Schoonen WM, Farkas DK, Riis A, Fryzek JP, Sørensen HT. Mortality risk in splenectomised patients: a Danish population-based cohort study. Eur J Intern Med. 2010;21(1):12–6.
Thomsen RW, Schoonen WM, Farkas DK, Riis A, Jacobsen J, Fryzek JP, Sørensen HT. Risk for hospital contact with infection in patients with splenectomy: a population-based cohort study. Ann Intern Med. 2009;151(8):546–55.
Theilacker C, Ludewig K, Serr A, Schimpf J, Held J, Bögelein M, Bahr V, Rusch S, Pohl A, Kogelmann K, Frieseke S, Bogdanski R, Brunkhorst FM, Kern WV, Splenectomy, Pneumococcus, and Fulminant Infection SPLEEN OFF Study Group. Overwhelming postsplenectomy infection: a prospective multicenter cohort study. Clin Infect Dis. 2016;62(7):871–8.
Kristinsson SY, Gridley G, Hoover RN, Check D, Landgren O. Long-term risks after splenectomy among 8,149 cancer-free American veterans: a cohort study with up to 27 years follow-up. Haematologica. 2014;99(2):392–8.
Schilling RF. Spherocytosis, splenectomy, strokes, and heart attacks. Lancet. 1997;350(9092):1677–8.
Linet MS, Nyrén O, Gridley G, Adami HO, Buckland JD, McLaughlin JK, Fraumeni Jr JF. Causes of death among patients surviving at least one year following splenectomy. Am J Surg. 1996;172(4):320–3.
Mellemkjoer L, Olsen JH, Linet MS, Gridley G, McLaughlin JK. Cancer risk after splenectomy. Cancer. 1995;75(2):577–83.
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Kowata, S., Ishida, Y. (2017). Splenectomy. In: Ishida, Y., Tomiyama, Y. (eds) Autoimmune Thrombocytopenia . Springer, Singapore. https://doi.org/10.1007/978-981-10-4142-6_15
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DOI: https://doi.org/10.1007/978-981-10-4142-6_15
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