Too old at age 73 for a splenectomy?

Hi to everyone,
A little personal history: in 2009 during my annual check-up my regular doctor was surprised to see that my platelet count was only 15k. He recommended a very kind, knowledgeable hematologist who put me on Prednisone. Within weeks I had had three Atrial-fib episodes in a row: up till then I had had an episode every 2-3 years. It was clear that the steroids were the culprit behind three episodes of A-fib in a couple of weeks - so, no more Prednisone! I was then given IVIg which seemed to work well - pushed my count up to 80-100k. But then it would drop again within a week or so. My platelet count finally dropped to 8k and I was hospitalized. I was then given Retuxin which I responded to well - my count went up to 80k-100k and stayed there for about 3 years. Then in the 4th year it began to slowly drop and now, as I approach the 5th year since having the Retuxin, my count runs between 40k-70k and is clearly (albeit slowly) going back down. My hematologist is now recommending that I consider a splenectomy.
My problem: I'm 73 and I hear that a splenectomy is less successful as we age. In addition when you've lost your spleen I realize that your immune system is weakened to some degree and I hear that this is dicey when you're over 70. Anybody have a comment on splenectomy when you're my age? Or any reactions to my options? BTW, I take medication for my A-fib and also for High blood pressure. I appreciate the impressions of you good folks who have experienced this disease and have to trod the same road I find myself on.
Bert

I have a questions for you??

When your doctor first noticed your count was low were you there because of symptoms? If the numbers were found in a random blood work? how did you handle the low plateletes before the doctor found them?

If Rituxan worked and gave you a 4-5 year remission why not reuse that medication. Spleenectomy seems a little invasive at your age when Rituxan seems to work for you.


Are you too old for surgery at 73 that depends on your health and your ability to heal! Many people have surgery with issue while they are seniors. That said I am just curious why your doctor wants to cut you open at 73 when Rituxan clearly worked for you???

Youngsters manage low counts well as long as there is no bleeding but an older person needs to be more careful. After about the age of 60 the risk of internal or head bleeds is greater so keeping the count up to a good safe level is not a bad idea. However, I'd also wonder why Rituxan was not suggested again, or some of the other available drugs.

Splenectomy or not is a personal decision. I wouldn't have one at any age and certainly not in later years, but that's my personal choice.

I'd have to agree with Julia and Ann about using Rituxan again. It's true that splenectomy is less successful as we get older so if it doesn't work, what would you do then? You'd possibly use Rituxan and the combination of the two would leave you even more immunosuppressed.

Good luck with your decision.

Hi to all,
Thanks to everyone who responded - It's good not to feel alone with this disease. Here are my responses to a couple of your questions: I had gone in for my annual physical in 2009 and my doctor's nurse noticed my low blood count and my doc then referred me to a hematologist. How had I handled the symptoms before diagnosis? Well, I guess I handled it as well as I could since I had no idea I had the disease. Looking back on it, I'm surprised it wasn't spotted earlier. There were different symptoms - I had fallen a couple of years before my diagnosis and had ended up with a nasty-looking hematoma below the knee. My regular doc noticed it but didn't seem to be worried and it drained awayt after a few months... So I was oblivious until he did regular blood-work in 20O9 and panicked...
The reason my hematologist has given me for not doing Rituxan again, even though it was successful for over 4 years, is that it would be "hard on me" because of my age. But, of course, a splenectomy would be "hard on me" too... and the chances of it failing seem to rise appreciably as we age. Is anyone aware of seniors with ITP, still treating it successfully, living into the 80's? Sorry if the issue of mortality is unsettling to any of you guys, but at age 73 it is an issue and I'm personally comfortable talking about it. Thanks again for your support and insight. You guys are much appreciated.
Bert

Bert, people do live into their 80s with ITP. My haematologist of the past used to say that in her experience, and she was the expert for the south east of England, ITP generally burns itself out after a while, so that is always possible.

For me, I'm 59 now and definitely planning on living well past the 80s. I used the drug Nplate for 3 years and it has put me into a remission. Maybe Nplate is a drug you might consider trying. People are supposed to be on it for life but it seems to be putting a good percentage of people into remission. It has the advantage of not being an immunosuppressant. It just seems to work.

Bert:

Patients who are aware that they have ITP, are monitoring it and treating it, have very little risk of dying from it.

If Rituxan wasn't hard on you 4 years ago, why would it be now? Ann did have a good suggesdtion too - N-Plate or Promacta. Many people respond well, have few side effects and do well on a fairly low dose.

I really appreciate your comments - very encouraging and informative. I'll talk to my hematologist about NPlate and Promacta. They've never been mentioned in our discussions - since being on this forum I see them both mentioned often. They may be a new direction for me, as long as I don't react toward them as I did with the steroids which triggered all the Atrial-fib episodes.

Thanks for all that you folks do for those of us who've joined the "IPT club"... Bert

If your doctor is shy of giving you Rituxan again you could ask about the low dose option. Studies have shown that it works just the same but with fewer side effects. It doesn't seem to have generally caught on for some reason although some doctors in the UK do it that way. Low dose is just 100 mg a time instead of the usual high dose.

Thank you, Ann. I'll check with my hematologist on Wednesday about the low-dose option. Thanks to all of you, I have several things to discuss with her that could lead to new options. Your help is much appreciated.
Cordially, Bert