{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T21:17:06Z","timestamp":1777497426140,"version":"3.51.4"},"reference-count":19,"publisher":"SAGE Publications","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["CH"],"published-print":{"date-parts":[[2023,10,30]]},"abstract":"<jats:p>Immune thrombocytopenic purpura (ITP) is an autoimmune disorder characterized by a platelet count of less than 100 x 109 \/L, resulting from antibody-mediated platelet destruction. Treatment for ITP typically involves steroids, and intravenous immunoglobulins (IVIG) can be added. Splenectomy is performed in cases with refractory ITP. Rituximab can suppress immunity but has limited efficacy in ITP cases. Herein, we present a rare case of a 30-year-old female who was first diagnosed with ITP and underwent a splenectomy two years later. However, seven years after surgery, she was presented with symptoms of ITP. A splenic scan showed an accessory spleen in the spleen bed, for which she underwent accessory spleen removal surgery. Her laboratory tests three days post-operation showed a rise in platelet count and hence was discharged a few days later. The patient had recurrent attacks of ITP even after the removal of the normal and accessory spleen, suggesting that accessory spleen removal may not always be an effective treatment for ITP. The patient eventually died. While splenectomy is a common treatment for ITP, it may not always be effective in all cases, and other treatments such as bone marrow transplantation may be necessary.<\/jats:p>","DOI":"10.3233\/ch-231881","type":"journal-article","created":{"date-parts":[[2023,8,18]],"date-time":"2023-08-18T11:34:11Z","timestamp":1692358451000},"page":"189-194","source":"Crossref","is-referenced-by-count":3,"title":["Refractory immune thrombocytopenic purpura (ITP) after accessory splenectomy: A case report and literature review"],"prefix":"10.1177","volume":"85","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3765-7335","authenticated-orcid":false,"given":"Asad","family":"Riaz","sequence":"first","affiliation":[{"name":"Ayub Teaching Hospital, Abbottabad, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8077-5911","authenticated-orcid":false,"given":"Hossam Tharwat","family":"Ali","sequence":"additional","affiliation":[{"name":"Qena Faculty of Medicine, South Valley University, Qena, Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0942-8658","authenticated-orcid":false,"given":"Fawad","family":"Ali","sequence":"additional","affiliation":[{"name":"Hayatabad Medical Complex, Peshawar, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jawad","family":"Ali","sequence":"additional","affiliation":[{"name":"Ayub Teaching Hospital, Abbottabad, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","reference":[{"issue":"11","key":"10.3233\/CH-231881_ref2","doi-asserted-by":"publisher","first-page":"2386","DOI":"10.1182\/blood-2008-07-162503","article-title":"Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group","volume":"113","author":"Rodeghiero","year":"2009","journal-title":"Blood"},{"issue":"6","key":"10.3233\/CH-231881_ref3","doi-asserted-by":"publisher","first-page":"620","DOI":"10.1016\/j.autrev.2017.04.012","article-title":"Pathogenesis of immune thrombocytopenia","volume":"16","author":"Audia","year":"2017","journal-title":"Autoimmun Rev"},{"issue":"4","key":"10.3233\/CH-231881_ref4","doi-asserted-by":"publisher","first-page":"933","DOI":"10.1046\/j.1365-2141.2002.03669.x","article-title":"Fifty years of idiopathic thrombocytopenic purpura (ITP): management of refractory itp in adults","volume":"118","author":"Provan","year":"2002","journal-title":"Br J Haematol"},{"issue":"11","key":"10.3233\/CH-231881_ref5","doi-asserted-by":"publisher","first-page":"1172","DOI":"10.1182\/blood-2017-09-742353","article-title":"Splenectomy for immune thrombocytopenia: down but not out","volume":"131","author":"Chaturvedi","year":"2018","journal-title":"Blood"},{"issue":"1","key":"10.3233\/CH-231881_ref6","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1172\/JCI113060","article-title":"Mechanisms of thrombocytopenia in chronic autoimmune thrombocytopenic purpura. 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