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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 an indium labelled platelet spleen scan can be 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.
The ITP Support Association booklet ITP & Splenectomy gives further information on all aspects of splenectomy.
See this link for further information by the Health Protection Agency on minimising the risks of infection in people without a spleen.