Partial Splenic Embolization in Myelodysplastic Syndrome Associated with Immune Thrombocytopenia

Abstract

The observation during the treatment in this case suggests that partial splenic embolization may be a valid new alternative for treating thrombocytopenia due to alloimmunization.

The use of splenic embolization in immune thrombocytopenia: A systematic review and meta‐analysis

“…After exclusion of review publications and duplicate reports, 24 reports were included in the final analysis. Nine studies included five or more patients and these were used in the analysis of effectiveness (228 patients), 7,13,34–40 and 15 studies were included in the safety analysis (151 patients) 13,16,22,31,33–35,37–44 …”

“…Seven patients (4.6%) suffered from pleural effusion, and two suffered from splenic abscess (1.3%). Only one SE‐related death occurred, an immunocompromised patient who suffered from post‐procedural ileus and sepsis (0.7%) 42 . Most studies did not include the descriptions of pain intensity assessment or strategies for pain control following embolization.…”

“…Nine studies included five or more patients and these were used in the analysis of effectiveness (228 patients), 7,13,[34][35][36][37][38][39][40] and 15 studies were included in the safety analysis (151 patients). 13,16,22,31,[33][34][35][37][38][39][40][41][42][43][44]…”

“…Only one SE-related death occurred, an immunocompromised patient who suffered from post-procedural ileus and sepsis (0.7%). 42 Most studies did not include the descriptions of pain intensity assessment or strategies for pain control following embolization. While two studies provided the detailed measures of pain management, using continuous opioid infusion for up to 72 h post-embolization, 13,33 others mentioned that post-procedural pain was controlled with opioids without specific details.…”

“…[22][23][24][25][26][27][28][29][30][31][32][33]65 In addition, SE has been successfully applied to treat refractoriness to RBC transfusion secondary to hypersplenism, potentially predicting the utility of subsequent splenectomy. [66][67][68] Furthermore, though not included in the analysis of effectiveness, we identified 11 citations that described the successful use of SE in young and adult patients with ITP who were considered unsuitable candidates for splenectomy, 16,17,41,42,44,[69][70][71][72] declined surgery 73 or individuals who experienced ITP relapse post-splenectomy due to accessory spleen. 74,75 Like SE, splenic irradiation has also been extensively described as a viable alternative to splenectomy in patients with massive splenomegaly leading to debilitating symptoms with severe cytopenias, and who are not suitable candidates for surgery.…”