E2021. Partial Splenic Embolization in Medical Refractory Immune Thrombocytopenic Purpura
Authors
Kenneth Huynh;
University of California, Irvine
Louis Fanucci;
Oregon Health and Science University
Simon Long;
University of California, Irvine
Harold Park;
University of California, Irvine
Background
According to the most recent American Society of Hematology (ASH) 2019 guidelines for immune thrombocytopenia, medical therapies are the first-line treatment option for immune thrombocytopenic purpura (ITP) in adults with platelet counts <30,000/µL. In medically refractory cases or cases with life-threatening hemorrhage, splenectomy may be considered. However, many patients may be poor candidates for urgent splenectomy due to the risk of exsanguination and perioperative mortality and morbidity. Although the ASH 2019 guidelines do not mention partial splenic embolization (PSE) for ITP, PSE has been shown to be a safe and effective alternative treatment option to splenectomy, with similar response rates and fewer perioperative complications. Additionally, the functional residual spleen confers immune protection against infections for patients who would be otherwise susceptible post-splenectomy.
Educational Goals / Teaching Points
Review the pathophysiology of immune thrombocytopenic purpura and its manifestations. Review the most recent ASH 2019 guidelines for ITP management and the role of partial splenic embolization as an alternative treatment option. Present a case-based approach of medical refractory ITP with response to PSE with discussion of clinical and technical considerations.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
This exhibit will present manifestations of ITP including complications of life-threatening hemorrhage, including hemoptysis, melena, and intracranial hemorrhage. Illustrations of these complications and management thereof will be presented through a case-based approach detailing clinical workup, initial imaging, and intraoperative digital subtraction angiography (DSA) with accompanying clinical pearls and technical considerations. PSE via transradial artery approach with round particle embolization will be described with accompanying post-embolization cone beam computerized tomography (CBCT) of the spleen. Potential complications of PSE and their management will also be reviewed.
Conclusion
Although the ASH 2019 guidelines do not describe PSE for ITP, PSE serves as a safe and effective alternative or bridge to splenectomy in the management of ITP. When splenectomy for ITP is considered high risk, PSE can be considered when medical management has been ineffective.
