Breakdown of platelets occurs mainly in the spleen. If autoantibodies are bound to the platelets, they are more quickly captured and broken down by the spleen.
Removal of the spleen (splenectomy) may be considered if treatment with medication is not sufficiently effective. This surgery is not recommended within one year of diagnosis, as it can only be determined after 12 months whether chronic ITP is involved. Contrary to the (recent) past, both patients and doctors are much more reluctant to have a splenectomy performed. The removal of the spleen, especially in children, is postponed as long as possible.
It is recommended that a scan of the spleen be made prior to splenectomy to ensure that the spleen - and not the liver - is responsible for breaking down the platelets. This ensures that the likelihood of removal of the spleen actually having the desired effect is known in advance. Sometimes removing the spleen does not have sufficient effect, because a supernumerary spleen can form after the operation which then breaks down platelets, or because platelets are broken down in the liver.
To date, a spleen scan is only possible in the Haga hospital in The Hague.
The spleen has an important function in the defence against certain bacterial infections and blood-borne parasites. The risk of such infections therefor increases after removal of the spleen.
Infection prevention and measures
Both vaccination and antibiotic prophylaxis are important aspects of infection prevention in asplenia and should be performed.
A vaccination is always given before a splenectomy in order to prevent bacterial infections. This vaccination has to be repeated regularly. It is recommended that patients due to have their spleen removed are vaccinated against pneumococci, Haemophilus influenzae type B (HiB) and meningococci. These vaccinations have recently been added to the Netherlands’ National Vaccination Programme for children.
The prophylactic and/or therapeutic (on-demand) use of Antibiotics is a second measure to prevent serious infections after splenectomy. Adults are advised to use antibiotic prophylaxis daily for 2 years after splenectomy (children up to the age of 5 years and up to 2 years after splenectomy).
A possible infection must also be treated as soon as possible (= on demand use: start antibiotics immediately (< 1 hour) in case of fever/febrile feeling). Splenectomized persons should therefore always carry antibiotics to be able to start therapy immediately.
All infections should be taken seriously after removal of the spleen. Infections transmitted by dog bites can be particularly serious. The immune system’s resistance to malaria is also reduced after a splenectomy.