transplant patient who has ITP

Daughter is a heart transplant recipient who was diagnosed with ITP in late May. Did not take well to Rituxant or prednisone. Doing well with Nplate. Getting ready to schedule Splenectomy but her numbers went from 64 to 164 with her last NPlate dose. It's such a difference. Any opinions?

Nplate is doing well on her. 164 is very good number which is in normal range. If she was me I would not do splenectomy. When you do it you cannot take it back.

If your daughter has had a transplant she is probably taking immunosuppressants so without a spleen she would be doubly immunosuppressed. Just something to think about. Splenectomy is gradually disappearing as a treatment for ITP as the new drugs like Nplate are coming along.

I agree with Ann. What immunosuppressant does she take?

prograff

Generic name is tacrolimus. Are you seeing a haematologist who is experienced with ITP? Doctors are not very good at dealing with anything outside their own specialty so sometimes you have to see two doctors and juggle the advice they give and make more of a decision yourself.

Your daughter is immunosuppressed with drugs, and now with the rituxan which will keep her suppressed for something like a year. Personally I wouldn't be looking at a splenectomy which will make her even more suppressed. The Nplate seems to be working so why not stick with that? It is preferable with Nplate to keep counts as low as possible, around 50 is good so you need to adjust the dose to keep it there or use it less often... whatever it takes really.

Just to add though, I'm not a doctor. Just an adult with ITP so what I'd do may not be right for everyone.