Splenectomy: Critical Information on This Surgery

By Michelle Ponte

If you’re living with ITP and considering having a splenectomy (spleen removal), you’re far from alone. For many, simply living with low platelet counts, bleeding and bruising year after year, and being unable to find the right treatment, is reason enough to have the surgery.

Having a splenectomy does not cure ITP, but many patients have benefited from it and had their platelet counts return to normal or go high enough to stop treatment. But it’s also important to know the risks of  a splenectomy. The truth is splenectomies don’t always work, or they may only last for a period of time. And once you’ve had the surgery, you’re forever without the spleen’s immune system benefits, such as protection from some illnesses.

Before you commit to having a splenectomy, there are many factors to consider with your doctor, including your age, health condition, ITP symptoms and platelet count history. Read on for more facts about the procedure.

Splenectomy basics

A splenectomy is a surgical procedure that removes the spleen, an organ the size of your fist that filters the blood and keeps the immune system healthy. The first splenectomy was in 1913. Splenectomies are generally recommended when your platelet counts are less than 30,000 and you have serious bleeding symptoms. So why remove the spleen if you have ITP? Well, this organ plays an important role in the manifestation of ITP because it removes platelets from the bloodstream and the body. It also produces antiplatelet autoantibodies, which destroy platelets. Ultimately, having a splenectomy can be beneficial to those with ITP because it stops a major resource of platelet destruction in the body. 

Splenectomy risks

A splenectomy may seem like a logical move since the spleen is one of the main areas in the body that destroys platelets. However, platelets can still be destroyed by the liver and in the bloodstream, and in some cases the spleen can even develop what is called an extra spleen, which requires a second surgery.

While medical research shows that about 66 percent of splenectomies are a success for people with ITP, your platelet counts could begin to fall again if they are being efficiently destroyed in other parts of the body. And one of the biggest risks of having a splenectomy is that your immune system becomes compromised since the spleen also fights off infections and filters out bacteria. This means you may be at a greater risk for and struggle to recover from certain illnesses and infections, including pneumonia, meningitis, malaria and hospital-acquired infections.

Why age matters

Research has shown that people who have splenectomies under age 40 have a better success rate. Splenectomies after age 60 are not as effective and after age 65 your risk for complications and even death increases.

Know your surgery, know your surgeon

If you decide to have a splenectomy, don’t be shy about asking your doctor to recommend a surgeon who regularly performs the procedure. One of the primary qualifications will be a surgeon who has done 100 or more splenectomies. Also, be persistent and interview potential surgeons and even consider visiting the surgery center. It’s important that you're comfortable with who is performing the surgery and where it's being performed.

Talk to your surgeon about having a laparoscopic surgery. This is a less invasive method of removing the spleen through a smaller incision in the abdomen. It has the same success rate as a surgery done with a larger incision, but a quicker recovery time, fewer complications and less scarring. 

Be aware that all surgeries do come with a small risk of complications. For splenectomies, complications include infection, bleeding, blood clots and pneumonia. Also, you may experience some pain at the incision site for several days following the surgery. Since your immune system will be more compromised, ask your doctor what vaccinations (such as those given for pneumonia and the flu) should be taken before the surgery.

Published July 2011

ITP Basics
What Is ITP?
ITP Causes & Risk Factors
ITP Symptoms
ITP Diagnosis
Your ITP Healthcare Team
Questions to Ask Your Doctor
Top 3 Myths About ITP

 

ITP Treatment
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Splenectomy: Critical Information
    on This Surgery
How Medication Can Help Your ITP
Treating ITP With Corticosteroids
ITP Drug-Safety Guide

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