Splenectomy or Nplate?

Just finished my 4th dose of Rituxan 3 days ago and my counts are still in the single-digit range. Had IVIG yesterday, the side effects sent me to ER afterwards (first ER experience in my life).
Luckily I was released from hospital the same day and today I feel totally fine again.
Now my doctor think I should really seriously consider a aplenectomy if my counts don't improve within the next couple of weeks. Having defended my spleen for the past 5 years, I still don't find the idea of removing my spleens exciting ... I'm thinking to explore the new drugs: Nplate or Promacta ... but some people suggest that they would rather do a splenectomy because it is such a mature procedure and has been a clinically approved remedy for ITP for the past several decades. In comparison, the new drugs might have some long-term side effects we are not aware of yet.
I would like to know what your thoughts are.
Thank you.

Back in /04 when I was diagnosed, my hema suggested a splenectomy. I said unless he could prove it was my spleen causing the ITP, no way. Two years later I gave in, just because I wanted off the Pred and had done everything that was available to me at the time. It worked, for a couple of weeks, then I was right back in the same boat. I can't honestly say I'm sorry I did it; just sorry it didn't work. So between /06 and /10, I was doing regular IVIG treatments. Finally got approved for Rituxan last year and did my four treatments in Sept./Oct. I had a rise in the first week and have been in the normal range since then. At least until this past Sunday. I went from 254k to 35k in two months.

If you prefer to try one of the new treatments, I say go for it. Don't let any doctor push you in to something you don't want. Mine didn't; he let me make the decision on my own.

Good luck with whatever you decide to do.

The rituxan treatments generally can take a while to work. For me they did not really kick in until 4 to 6 weeks out of the last treatment. As far as splenectomy it works in a certain percentage of people. I had already had a splenectomy for a different blood disorder 5 years before I developed ITP. Before I had the splenectomy I did get a second opinion and that made me feel better about the decision.

Splenectomy may be a well recognized ITP treatment, but new research keeps popping up difficulties that can arise in asplenic individuals. It is not without risks and most doctors are not aware of the newer problems. There may also be more problems from splenectomy that we do not know yet. Tough decision, but I'd still give Rituxan more time.