Critical issues concerning splenectomy for chronic idiopathic thrombocytopenic purpura in childhood

Guidelines for management of chronic idiopathic thrombocytopenic purpura (ITP) in childhood are still based on expert opinions and therefore remain controversial. Splenectomy is an established option for chronic ITP in adults, but splenectomy in childhood is complex, due to higher probability for spontaneous recovery of ITP as compared to adults, psychological barrier of parents to accept a permanent organ loss, lack of reliable preoperative response prediction, and risk for overwhelming sepsis in young children. Parents are confronted with fear of intracranial bleeding, burden of responsibility in daily life, frequent visits to doctors, and need for restrictions of physical activities. Decision is further complicated by emerging conservative options offering durable remissions. This article reviews existing recommendations for splenectomy in pediatric chronic ITP and delineates critical and unsolved issues.