title: Is there any Role for Splenectomy in Adulthood Onset Chronic Immun e Thrombocytopenia in the Era of TPO Receptors Agonists? A Critic al Overview.
abstract: Immune thrombocytopenia (ITP) in adulthood is characterized by chronic relapsing course. Despite the efficacious first line treatment (corticosteroid, intravenous immunoglobulin), majority of patients will enter the chronic phase warranting another treatment approach. Until recently, splenectomy performed in ITP chronic phase represented the standard of care with longterm remissions in more than 70% of patients, but it has never been tested in clinical trials. However, with the advances of our understanding of ITP pathophysiology and the shifting focus on megakaryocyte impairment, novel drugs were introduced in the treatment paradigm, mainly trombopoietin receptor agonists (TPO-RAs); romiplostim and eltrombopag.
  
  
  
  These TPO-RAs were tested in randomized controlled trials resulting in adequate platelet response with few side effects and less need for additional therapy leading to approval of corresponding regulatory agencies and wide acceptance by hematological community, but however TPO-RAs must be taken continuously to maintain the response. With their onset, the rate of splenectomy in chronic ITP has diminished in modern era.
  
  
  
  The main aim behind conducting this review is to evaluate the pros and cons of splenectomy compared to TPO-RAs treatment in order to provide the critical overview which may help the practicing clinician in managing often challenging cases of chronic ITP.
authors.affiliation: Lombardi Comprehensive Cancer Centre, Georgetown University, 3970 Reservoir Road NW E501, 20007 Washington D.C., United States.
authors.forename: Milunovic
authors.initials: M
authors.lastname: Vibor
authors.affiliation: Division of Hematology, Clinical Hospital Center, Zagreb. Croatia.
authors.forename: Inga Mandac
authors.initials: IM
authors.lastname: Rogulj
authors.affiliation: School of Medicine, University of Zagreb, Zagreb. Croatia.
authors.forename: Slobodanka Kolonic
authors.initials: SK
authors.lastname: Ostojic
mesh_terms: D000328:Adult; D001565:Benzoates / Q000627:therapeutic use*; D001792:Blood Platelets / Q000187:drug effects / Q000473:pathology; D002908:Chronic Disease; D006801:Humans; D006834:Hydrazines / Q000627:therapeutic use*; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D011720:Pyrazoles / Q000627:therapeutic use*; D011961:Receptors, Fc / Q000627:therapeutic use*; D053628:Receptors, Thrombopoietin / Q000819:agonists*; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use*; D013156:Splenectomy; D013926:Thrombopoietin / Q000627:therapeutic use*
chemical_list: D001565:Benzoates; D006834:Hydrazines; D011720:Pyrazoles; D011961:Receptors, Fc; D053628:Receptors, Thrombopoietin; D011993:Recombinant Fusion Proteins; D013926:Thrombopoietin; C488777:romiplostim; C520809:eltrombopag
keywords: Immune thrombocytopenia; eltrombopag; romiplostim; splenectomy; thrombopoietin receptor