To Splenectomy or not to splenectomy?

Is a partial splenectomy an option for treatment of hypersplenism?

Basically from what I can see no it not even spoken about.

www.hindawi.com/journals/tswj/2014/961345/

an interesting read

But do they do partial splenectomy with splenomegaly which Mark also has? I don't know, I haven't looked that one up. Does it say in the article?

there is no mention that I can see about enlarged spleens

I don't think anyone can answer the question as to whether or not you should have a splenectomy but I can share my experience with you. I've had various treatments for ITP and went into remission for 5 years. Around a year ago it came back. Treatments were tried and failed and a Splenectomy was offered. I asked for an Indium screening scan which I had and it was inconclusive. I have an occupation whereby I need a decent platelet count due to the risk of injury so decided to take the plunge and had a splenectomy in Dec 15.
The operation went well. I was in hospital for 2 days and went home. I was able to walk around the day after the operation. Obviously it was painful but this was managed.
My platelet count dropped after the operation and continued to drop steadily for a few weeks but has started to slowly rise. 2 weeks ago it was 105 and I'm having another blood test tomorrow so hopefully it will be higher.
As for how I feel minus a spleen, it's made very little impact to my life. I'm not constantly tired, my immune system seems better ( however the surgeon did say my spleen was badly scarred and had started to decompose) I've not even had a sniffle or a cough and everyone around me seems to have had chest infections and colds !!
The impact on me is minimal, two penicillin tablets a day.
I can only pass on my experience to offer an insight from my point of view. Others may have vastly different experiences. Even if it turns out not to have worked it doesn't matter to me because having my spleen removed has had no negative impact on me at all.

I had my spleen taken out in 1999 and my counts remain over 400. I had several sinus/strep infections the first couple of years because I was around young children. Now that my kids are away at college, I have not had any type of infection in several years. I travel with a zpac, make sure I keep up with vaccinations and take a lot of vitamins to keep up my immunity. I would highly recommend the spleenectomy!!! The steroids and other treatments were horrendous and I've not had any other worries with ITP since the spleenectomy.

I'd rather have a splenectomy over other treatments such as prednisone. For me, the months I was taking prednisone were hell. I honestly believe if I'd continued to take them they would have killed me !

A recent study suggests that responsiveness to IVIG is a strong predictor of responsiveness to splenectomy.
I would like to see this study repeated and with a larger sample size, before I could trust it.

www.e-sciencecentral.org/articles/SC000013072
Factors Predicting Response to Splenectomy in Patient with Immune Thrombocytopenia Purpura
Objective:
Splenectomy has been proposed to be the standard therapy for patients with steroid refractory immune thrombocytopenic purpura (ITP). This study aimed to describe valuable factors predicting the effect of splenectomy in patients with ITP.
Methods:
A total of 51 adult patients who underwent splenectomy for steroid refractory ITP were evaluated their medical records retrospectively. The response to the treatment was classified on the basis of the platelet count.
Results:
The responding group included 35 patients (68.8%), the partial-responding group included 4 patients (7.8%), and non-responding group was 12 patients (23.5%). On univariate analysis, the response of splenectomy correlated with only the intravenous immune globulin (IVIG) response (66.7%, P=0.006), but hemolysis, autoantibody, a presence of accessory spleen, the response of steroid were not significantly associated with the effect of splenectomy. On multivariate analysis, the response of IVIG and the amount of platelet transfusion were independent variables of the response of splenectomy.
Conclusion:
Patients with ITP who have good responses to IVIG are likely to have a good or favorable responses to splenectomy.

They have gone back and forth on that issue for many years. First it did, then it didn't, then it did then it didn't. Wonder why they are even studying this now since neither of those are popular treatments these days?

Hey Mark,
Havent been on the site for a few years because splenectomy worked great. Had a few infections since then, one the first week. The first 2 years I ended up in the hospital about 5 or 6 times with an infection. Usually something weird, but even the flue would put me in the hospital for 3 or 4 days because it would be so bad. The 3rd year only ended up twice having to stay in the hospital. I think this is going on the forth year and i have been good. I am a little more paranoid now than I was in the beginning. I do not wait for my temp to get above 101 or what ever they told me to wait till before I come in. My temp seems to run low, 96.8 (not 98.6) so when my temp gets at 99.0 I start to watch it real good and start taking my emergency antibiotics. At 99.5 I head into the hospital, they send me right home, but I feel better about it that I covered my bases. Had ulcerative colitis in my early twenties and at times would have shot my self if I had a gun. My son has crohns real bad, so I do know what that is like. I dont know about the rest of the things you have, but sounds like your plate is full. Must be hard with colitis and ITP. That would make me worry. What are your numbers?
I would get the splenectomy again. My numbers had dropped to 3 before then splenectomy. My numbers had started to drop sooner and faster with the more treatment and different meds they would try. Some of them went from a few days or a week to just a few hours before they would fall out. No one wanted me to get a splenectomy, my wife, mother, pc doc, another hemo doc, people on this. Everyone except my VA hemo doc. She had said nothing is or will work for you, and I believe she was right.
I do worry about what will happen if my numbers do drop again. I also do think that when I do die it will be by an infection, just hope its not to soon.
My ITP was triggered by medication they had put me on 2 weeks before.
I hope this helps a little.
Neil Buck

My numbers run just above 500 now. I do still feel tired and worn out a lot, and people dont seem to understand that, even my pc doc. They tend to think because you dont have a spleen you dont have ITP. ITP is still there and you still feel its side effects, you just dont worry as much about bleeding to death from a splinter.
My spleen was way to big, they tried getting it out with the 3 little holes, dont remember what they call it, but they ended up having to cut about 3 1/2 inches to get it out. Doc said it was because it was just collecting so many platelets so fast.??
Neil Buck