Two Patients With Resistant Immune Thrombocytopenic Purpura and Portal Hypertension Treated Safely With Laparoscopic Splenectomy: A Case Series Report and Literature Review

Immune thrombocytopenia (previously called idiopathic thrombocytopenic purpura (ITP)) is characterized by an autoimmune destruction and clearance of platelets and megakaryocytes by reticuloendothelial system including liver and spleen. Most of the time, it occurs in the absence of any obvious stimulus. Secondary immune thrombocytopenia coexists with an underlying disease such as human immunodeficiency virus (HIV), hepatitis C virus (HCV), chronic lymphocytic leukemia (CLL), systemic lupus erythematosus (SLE), or can occur following exposure to certain drugs such as heparin or quinidine. Medical treatment includes corticosteroids, intravenous immunoglobulins and rituximab. Splenectomy is reserved for patients who fail medical therapy. Laparoscopic splenectomy is safer than open splenectomy. The main surgical complication of splenectomy is intra-abdominal bleeding. Additional risk factors for post-operative bleeding such as portal hypertension can alter treatment decision in regard to splenectomy. J Curr Surg. 2019;9(4):61-65 doi: https://doi.org/10.14740/jcs399