Study In The Effect Of Partial Splenic Embolization On Refractory Immune Thrombocytopenia

BackgroundPrimary immune thrombocytopenia(ITP) is a bleeding disorder characterized by too few platelets in the blood.This is because platelets are being destroyed by the immune system including spleen or auto-antibodies. Symptoms may include bruising, nosebleed or bleeding in the mouth or into the skin, and abnormally heavy menstruation.For the first line treatment, prednisone cures some of the patients. But60%-70% of ITP may become a relapse and refractory in adults.Second line therapy includes immune inhibitors, splenectomy and Rituximab, Romiplostim.Partial splenic embolization has been applied in ITP with relapse and refractory.ObjectiveTo explore the possibility of partial splenic embolization(PSE) for relapse and refractory ITP, we observed the respond rate and duration of curative effect after partial splenic embolization.Methods14 patients with refractory ITP operated partial splenic embolization were hospitalized in Zhangzhou Affiliated Hospital of Fujian Medical University from2010 to 2015.Partial splenic embolization was according to the stander procedure,and the embolized volume was about 60~80%.Splenectomy is under the laparoscope with 10 patients.Informed consent was obtained.These patients received partial splenic embolization including 2 men and 12 female, with age ranged from 16–67. Follow-up period was 3~72 months. The patients operated splenectomy including 3 men and 7 female, with age ranged from 23–60.Follow-up period was 6~60 months. Complete response rate(CR), response rate(R), no response rate(NR) and postoperative complications, duration of remission were observed. Statistical was analyzed by SPSS23.0, and P<0.05 was considered significant.Results10 cases(71.4%) achieved in CR, 1 case(7.1%) in R and 3 cases(21.4%) in NR after 1 week with partial splenic embolization. 6 cases(42.9%) achieved in CR, 5cases(35.7%) in R and 3 cases(21.4%) in NR after 1 month. 8 cases(57.1%)achieved in CR, 4 cases(28.6%) in R and 2 cases(14.3%) in NR after 3 months. 4cases(44.4%) achieved in CR, 3 cases(33.3%) in R and 2 cases(22.2%) in NR after 6 months. 5 cases(62.5%) achieved in CR, 2 case(25.0%) in R and 1 case(12.5%) in NR after 1 year. 4 cases follow up for 3 year, 3 cases(75.0%) achieved in CR, and 1(25.0%) achieved in R. For the patients who operated splenectomy, 8cases(80.0%) achieved in CR, 2 cases(20.0%) in R after 1 week. 7 cases(70.0%)achieved in CR, 2 cases(20.0%) in R and 1 case(10.0%) in NR after 1 months. 8cases(80.0%) achieved in CR, and 2 cases(20%) in NR after 3 months. 7 cases(70.0%) achieved in CR, 1 case(10.0%) in R and 2 cases(20.0%) in NR after 6months. 3 cases follow up for 1 year, 2 cases(66.7%) achieved in CR, and 1(33.3%)achieved in R. 3 cases follow up for 3 year, all achieved in CR. The respond rate is similar between PSE and splenectomy(p>0.05). In PSE, 11 of them experience abdonminal pain, 2 have fever. In splenectomy, 10 of them experience abdonminal pain, 1 pneumonia, 1 peripheral inflammation of spleen, 1 intraperitoneal infection,2 intraperitoneal hemorrhage, 1 acute pancreatitis, 1 throbocytosis. There was no different in age, gender, platelet, response rate between two operations(P>0.05).All of the patients reduced dosage of steroid.ConclusionsPartial splenic embolization for patients with relapse and refractory ITP could be effective therapy. It improved platelets, alleviate hemorrhage, reduced the dosage of steroid. It has the same effect as the splenectomy, less complication. It might be recommendation for relapse and refractory ITP instead of splenectomy.