Robotic Splenectomy as a Salvage Therapy Post Failed Splenic Embolization in Chronic Immune Thrombocytopenic Purpura Due to the COVID-19 Vaccine

Abstract

Refractory immune thrombocytopenic purpura (ITP) is a rare autoimmune condition that does not respond to medical treatment and poses significant challenges in management due to the risk of severe bleeding. This report discusses the challenges in managing a 65-year-old male patient with ITP secondary to the second COVID-19 vaccine and refractory to medical and surgical therapy who underwent robotic splenectomy. After failing multiple cycles of high-dose corticosteroids, IVIG (intravenous immunoglobulin), and romiplostim, the patient underwent sub-selective splenic artery embolization (SAE). After 26 months, the spleen retained its size, and he underwent a second sub-selective SAE followed by an elective robotic splenectomy, which converted to an open procedure due to intraoperative bleeding. Seven days post-op, the patient's platelets rebounded to adequate levels, and he was discharged on post-op day eight. The patient had evidence of thrombocytopenia at follow-up on postoperative day 24 that rebounded by postoperative day 66. This patient's unique treatment course highlights various medical and surgical challenges in the armamentarium for patients with ITP.