Splenic artery embolization as a bridge to splenectomy in severe transfusion-refractory thrombocytopenia secondary to myelodysplastic syndrome

Abstract

Transfusion-refractory thrombocytopenia is an important clinical challenge in the treatment of patients with myelodysplastic syndrome. Hypersplenism can play a major role in splenic platelet sequestration and transfusion refractoriness, and though rare in myelodysplastic syndrome, it can commonly be seen in a wide range of other benign and malignant conditions. Splenectomy has been an effective approach in management of hypersplenism-induced cytopenias, however those who are unresponsive to platelet transfusions are not surgical candidates making this an unfeasible treatment option. There has been increasing interest in the therapeutic value of the less invasive procedure of splenic artery embolization. Here we report the first case of a patient with myelodysplastic syndrome complicated by hypersplenism and severe transfusion-refractory thrombocytopenia in which a splenic artery embolization was successfully used as a bridge to splenectomy, which resulted in platelet transfusion responsiveness and correction of her thrombocytopenia. Reversal of severe thrombocytopenia has multiple important therapeutic values including allowing patients to safely continue receiving myelosuppressive chemotherapy treatments which are sometimes delayed or dose-adjusted due to cytopenias, safely undergo surgical interventions and also open the door for candidacy for stem cell transplantation. In conclusion, splenic artery embolization with or without subsequent splenectomy is highly recommended as a safe therapeutic option in patients with hematologic malignancies.