Partial Splenic Artery Embolization in the Management of Acute Immune Thrombocytopenia Refractory to Medical Treatment

Abstract

Our case details a 60-year-old man with cirrhosis from hepatitis C referred to hematology for severe thrombocytopenia after right hemiglossectomy in the setting of squamous cell tongue cancer. Acute immune thrombocytopenia was diagnosed. Platelet transfusions, high-dose steroids, intravenous immunoglobulin ×2, romiplostim, and rituximab were administered without adequate platelet response (2000/µL), and patient developed gastrointestinal bleeding. Partial splenic artery embolization was performed urgently for refractory thrombocytopenia resulting in ∼60% splenic infarction. His platelet count increased in the next few days and was sustained. Our case demonstrates partial splenic artery embolization as an underused approach to severe thrombocytopenia in the setting of acute immune thrombocytopenia resistant to steroids and medications.