How does ITP affect the spleen?
How does ITP affect the spleen?
The spleen acts like a large lymph node, helping to maintain a healthy immune system and cleaning the blood of foreign matter. In ITP, the antibody-coated platelets are often removed from circulation by the spleen. Theoretically, if the spleen is removed, the platelets will remain in the blood stream.
Can ITP return after a splenectomy?
Therefore ITP is the most common indication for elective splenectomy, unfortunately, even when surgery successfully achieves platelets count remission, there is not guarantee that the disease will not recur. A review of the literature shows ITP recurrence following splenectomy ranging between 18% to 38% (17-9).
What happens to platelet count after splenectomy?
It is important for physicians to be familiar with the complications associated with thrombocytosis. Postsplenectomy reactive thrombocytosis has an incidence of about 75% to 82%. Thrombosis in association with elevated platelet count after splenectomy is well recognized, with an incidence of approximately 5%.
Does splenectomy cause thrombocytopenia?
Splenectomy is a major treatment modality when more conservative medical therapy has failed. Despite an initial response rate of 70–80%, 15% of patients will develop a recurrent thrombocytopenia.
Why is the spleen removed in ITP?
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.
Is the spleen enlarged in ITP?
Certain immune problems, such as lupus and immune thrombocytopenic purpura (ITP) Certain conditions that can cause an enlarged spleen, such as cirrhosis and cancer.
What is the life expectancy of someone with ITP?
Predicted 5-year mortality rates ranged from 2.2% for patients younger than 40 years to 47.8% for those older than 60 years. A 30-year-old woman remaining thrombocytopenic due to ITP was predicted to lose 20.4 years (14.9 quality-adjusted life years) of her potential life expectancy.
What is an accessory spleen?
An accessory spleen, also called a supernumerary spleen, a splenule, or a splenunculus, is a benign and asymptomatic condition in which splenic tissue is found outside the normal spleen. Accessory spleens are a relatively common phenomenon with an estimated 10% to 30% of the population having one.
Why would a patient need a splenectomy after a diagnosis of ITP?
When splenectomy is done in ITP?
Splenectomy is an effective therapy for steroid-refractory or dependent immune thrombocytopenia (ITP). With the advent of medical alternatives such as rituximab and thrombopoietin receptor antagonists, the use of splenectomy has declined and is generally reserved for patients that fail multiple medical therapies.
Why spleen is removed in ITP?
How are accessory spleens different from normal splenic tissue?
Accessory spleens are congenital nodules of normal splenic tissue. The spleen forms from multiple smaller components during embryogenesis and failure of this fusion can lead to one or more nodules remaining separate 2. Each component is extraperitoneal. They should not be confused with splenosis (see below) which is acquired and intraperitoneal.
When to remove accessory spleens for autoimmune disorders?
In patients who undergo splenectomy for autoimmune disorders (most commonly idiopathic thrombocytopenic purpura and autoimmune hemolytic anemia ), the growth of unrecognized accessory spleens is a classic cause of late relapse. Thus, accessory spleens should be identified preoperatively to ensure their removal.
How big does a splenunculus scan have to be?
In rare instances, the diagnosis can be confirmed with a Tc99m sulfur colloid scan which will demonstrate increased uptake as long as the splenunculus is at least 2 cm in diameter. Splenic tissue (spleen and accessory spleens) will demonstrate intense physiological uptake 5. Accessory spleens generally do not require any form of treatment 6.
What are the nodules in the spleen called?
Splenunculi (also known as supernumerary spleens, accessory spleens, or splenules ) are small nodules of spleen that are separate from the rest of the organ. They are common, seen in up to 16% of CTs of the abdomen and up to 30% of autopsies 2 .
