Partial Splenic Angioembolization for Refractory Chronic Immune Thrombocytopenia: A Case Report.

Abstract

Despite observed and theoretical effectiveness and safety in immune thrombocytopenia (ITP), partial splenic angioembolization has not yet been included in clinical practice recommendations. At present, this is the first and only recorded case of partial splenic angioembolization done for chronic ITP in our institution. This case report will add to the growing body of evidence of partial splenic angioembolization as a viable and attractive alternative in treating refractory ITP among patients who refuse or are otherwise unfit for surgery. We present a 61-year-old female, known chronic ITP unresponsive to steroids, vincristine, rituximab, mycofenolate mofetil, avatrombopag and azathioprine. She refused splenectomy and was offered partial splenic angioembolization. She achieved a durable response at post-procedure days 67, 82, and 130 with platelet count at 50 x 10⁹/L, 85 x 10⁹/L, and 72 x 10⁹/L, respectively, despite continued slow tapering of prednisone and discontinuation of TPO-RA and other immunosuppressive agents. Immune thrombocytopenia (ITP) results from decreased platelet function and increased platelet destruction. About 10% of ITP becomes refractory to treatment within a year. Even among hematologists, the management of refractory chronic ITP remains to be challenging. Splenic artery angioembolization has traditionally been used as an optimization prior to splenectomy of massively enlarged spleens. Its effectiveness in treating ITP remains uncertain. However, current practice endorses it as a rescue therapy in patients deemed unfit for splenectomy.