Questions on Spenectomy, contrast CT

I am so glad to find this forum. I never feel so vulnerable and donot know what to do. My mom (68 years old) was diagnosed ITP on April 17 at count of 10. She was hospitalized and was on Predsone 70mg for 3 days and her platelet increased to 43. Then she was continued on Predisone 60 mg and her platelet went up to 55. However, it then started to drop to 30. She was given IVIG. Her platelet count went up nicely (over 100). Understand IVIG is a temporary. Of cause, splenectomy was discussed. I am wondering if she should consider splenectomy first, or should try other medications like Nplate first?

They've performed BMB, everything looks normal. Also the doctor ordered the contract CT to exclude other possible cause for the low platelet count. just does not want to expose to more radiation if not necessary. wonder how many of you had CT scan? Thank you

Hello, I've never heard of anyone having a CT scan to diagnose ITP but of course there may be other considerations that are different. Did they say what they are hoping to rule out with the CT?

You should know that the rate of success for splenectomy falls rather sharply after the age of about 40 so the success percentage of 60% or so doesn't then hold good.

From a purely patient's viewpoint, I'd say that Nplate or Promacta which works in similar mode but is oral rather than a weekly injection, would be a good option. The unknown long term side effects are less of a worry to older people. At 57 I class myself in that bracket too and have used Nplate to good effect for nearly 3 years. One thing, in my opinion Nplate should be managed by a doctor experienced in ITP or they tend to do it wrongly adding in other drugs or panicking when the count falls instead of simply highering the dose, or worse, aiming to get a much higher count that is the purpose of the drug, and it all defeats the object.

Thank you for the information. It is really helpful. Looks like Nplate or Promacta may be better choice for my mom considering her age.

I believe the doctor would like to further rule out cancer (see if the lymph nodes are enlarged).

Hello - welcome! As you can see, there is a wealth of information here. If you have a question, just ask ~ usually someone has an answer.

I'm with Ann, most people do not have a CT scan when diagnosed with ITP. Sometimes people have an ultrasound of the spleen, but even that is not done very often. It's not on the protocol for diagnosing ITP. It couldn't hurt though I guess.

It's kind of soon to consider splenectomy. Sometimes a virus can cause ITP, or a medication or herbal supplement. Some people do go into remission within the first year, so having surgery is sort of drastic at this point. Also, as Ann said, the success rate is not that great after the age of 40. That can also open up a whole new set of problems to deal with, so you want to weigh the pros and cons carefully.

Sometimes the goal with ITP is not to achieve normal counts, but to be able to maintian a safe count. At your Mom's age, 50 should be a safe range. You don't have to panic if she falls below normal as long as she is safe.

You have quite a few options to consider. Be sure your doctor presents several of them. If he doesn't, I'd look for another opinion.