Long-Term Outcomes of Partial Splenic Embolization as a Therapeutic Intervention for Steroid-Resistant Immune Thrombocytopenia

Background: Primary immune thrombocytopenia (ITP) patients who don’t respond to steroid therapy have limited treatment options. One alternative intervention is partial splenic embolization (PSE). Objective: This study aimed to assess the effectiveness and safety of PSE in cases with steroid resistant ITP.
Patients and Methods: The current study included 24 adult cases with ITP who underwent PSE after failing to respond to steroid treatment. Analysis of platelet counts, changes in spleen diameter, complications, and failure free survival before and up to 12 months after PSE was done.
Results: Early response rates were favorable, with complete responses observed in 25% and partial responses in 58.3% of patients. Over time, the overall response rate increased to 79.1%, with 45.8% achieving complete responses. Complications were mainly post-embolization syndrome, and infrequent occurrences of bleeding, pleural effusion, and splenic abscess were reported, with no procedure-related deaths. Platelet counts significantly increased after PSE, and spleen size reductions were observed. Subgroup analysis revealed associations between platelet counts, spleen size, and late response. Patients with PLT counts at 1 month <73 × 10⁹/L were more likely to experience treatment failure.
Conclusions: PSE proves to be an intervention for ITP patients who do not respond to steroids providing long lasting platelet responses with significant reducing spleen volume in many cases. These results contribute to understanding predictive factors for treatment response and the potential role of PSE in managing steroid resistant ITP