Idiopathic thrombocytopenic purpura: current therapeutical strategies and review of the literature on outcome after splenectomy

Immune thrombocytopenia (ITP) is an immune and hematological disease resulting in low platelet count and high risk of hemorrhagic events. Therapy is challenging and the therapeutic outcome depends on multivariate factors, mostly still unknown and specific per-patient. Therefore, treatment should be tailored to the patient. Large randomized trials about the management of ITP are very few, resulting in significant therapeutic controversies. Indications and outcomes of splenectomy have considerably changed in the last years, because of improvement in medical therapy, especially for monoclonal antibodies. Furthermore, there are contradictory outcomes especially after surgical treatments in the Literature. For this reason, several guidelines have been formulated and revised in the last years. Recently, the American Society of Hematology published the new guidelines just focused on the management of ITP. In this systematic review of the Literature, we analyze the state of art about medical and surgical management of ITP and the therapeutic outcomes reported in the Literature, comparing them with the results from our studies.