Partial Splenic Embolization for Refractory Thrombocytopenia

Abstract

When the platelet count falls below 20×109/L, the risk of spontaneous life threatening hemorrhage is concerning for both physician and patient. When medical management fails, splenectomy is often used to manage the severe thrombocytopenia before spontaneous, life-threatening gastrointestinal or intracranial bleeding occurs. We present the non surgical management of such a patient with refractory sever thrombocytopenia who refused surgical intervention. She underwent partial splenic embolic therapy with 500–700μ particles. Her platelet count spontaneous recovered from less than 20×109/L to normal range. Her counts remained in normal range after discharge home. Further study is needed to determine the most appropriate role for embolization in patients who are refractory to medical management and those with chronically low platelet counts requiring frequent plate transfusions for invasive procedures.

The use of splenic embolization in immune thrombocytopenia: A systematic review and meta‐analysis

“…In addition, SE has been successfully applied to treat refractoriness to RBC transfusion secondary to hypersplenism, potentially predicting the utility of subsequent splenectomy 66–68 . Furthermore, though not included in the analysis of effectiveness, we identified 11 citations that described the successful use of SE in young and adult patients with ITP who were considered unsuitable candidates for splenectomy, 16,17,41,42,44,69–72 declined surgery 73 or individuals who experienced ITP relapse post‐splenectomy due to accessory spleen 74,75 …”

“…[22][23][24][25][26][27][28][29][30][31][32][33]65 In addition, SE has been successfully applied to treat refractoriness to RBC transfusion secondary to hypersplenism, potentially predicting the utility of subsequent splenectomy. [66][67][68] Furthermore, though not included in the analysis of effectiveness, we identified 11 citations that described the successful use of SE in young and adult patients with ITP who were considered unsuitable candidates for splenectomy, 16,17,41,42,44,[69][70][71][72] declined surgery 73 or individuals who experienced ITP relapse post-splenectomy due to accessory spleen. 74,75 Like SE, splenic irradiation has also been extensively described as a viable alternative to splenectomy in patients with massive splenomegaly leading to debilitating symptoms with severe cytopenias, and who are not suitable candidates for surgery.…”