Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2025 Mar 31;17(3):e81536.
doi: 10.7759/cureus.81536. eCollection 2025 Mar.

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

Danielle E Canfield  1 , Alejandro Pizano  1 , Tina Joseph  1
Affiliations
Case Reports

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

Danielle E Canfield et al. Cureus. .

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.

Keywords: covid-19 vaccine complications; immune thrombocytopenic purpura (itp); robotic splenectomy; splenic artery embolization; thrombocytopenia.

PubMed Disclaimer

Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Preoperative axial CT with contrast showing heterogeneous uptake in the enlarged spleen.
Figure 2
Figure 2. The patient's spleen post resection with areas of necrosis, measuring greater than 15 cm and weighing 450 g.
Figure 3
Figure 3. Graph depicting the patient's platelet count over the total course of his disease with notable moments in treatment.
SAE: splenic artery embolization
See this image and copyright information in PMC

References

    1. Justiz Vaillant AA, Gupta N. StatPearls [Internet] Treasure Island (FL): StatPearls Publishing; [ Aug; 2024 ]. 2023. ITP-immune thrombocytopenic purpura. - PubMed
    1. Thrombocytopenia including immune thrombocytopenia after receipt of mRNA COVID-19 vaccines reported to the Vaccine Adverse Event Reporting System (VAERS) Welsh KJ, Baumblatt J, Chege W, Goud R, Nair N. Vaccine. 2021;39:3329–3332. - PMC - PubMed
    1. Thrombocytopenia following Pfizer and Moderna SARS-CoV-2 vaccination. Lee EJ, Cines DB, Gernsheimer T, et al. Am J Hematol. 2021;96:534–537. - PMC - PubMed
    1. Refractory primary immune thrombocytopenia (ITP): current clinical challenges and therapeutic perspectives. Vianelli N, Auteri G, Buccisano F, et al. Ann Hematol. 2022;101:963–978. - PMC - PubMed
    1. Remission and platelet responses with romiplostim in primary immune thrombocytopenia: final results from a phase 2 study. Newland A, Godeau B, Priego V, Viallard JF, López Fernández MF, Orejudos A, Eisen M. Br J Haematol. 2016;172:262–273. - PubMed

Publication types

LinkOut - more resources