Elective splenectomy in children with idiopathic thrombocytopenic purpura

Purpose: The aim of this study was to review the safety and efficacy of elective splenectomy in children with idiopathic (immune) thrombocytopenic purpura (ITP). Methods: The authors reviewed the medical records of children with ITP treated with elective splenectomy at Children’s Medical Center of Dallas since 1961. Indication for splenectomy was symptomatic thrombocytopenia unresponsive to medical management. Results: Thirty-eight evaluable patients who had elective splenectomy for ITP were identified. Twenty-one (55%) were girls and 17 (45%) were boys. Twenty-two had splenectomy since January 1990. Age at diagnosis ranged from 6 months to 15.9 years (median 9 years), and age at splenectomy ranged from 3.6 to 16.4 years (median 11.8). Laparoscopic splenectomy was performed in 11 patients. No patient died and only one (2.6%) had postoperative hemorrhage. There were no other complications related to surgery. No cases of postsplenectomy sepsis were observed. At follow-up ranging from 1 month to 19.9 years (median 2.1 years), 29 patients (76.3%) had a normal platelet count (>150 × 10⁹/L) and 4 (10.5%) had a platelet count between 50 and 150 × 10⁹/L. Only two of the five (13.2%) remaining patients who continued to have a platelet count less than 50 × 10⁹/L had hemorrhagic manifestations necessitating intermittent therapy with corticosteroids. Conclusion: Laparoscopic or open splenectomy is a safe and effective procedure for children with chronic or refractory ITP and should be considered when medical management fails or causes excessive toxicity.