Impact of splenectomy on hematological outcomes and monoclonal gammopathy of undetermined significance development in patients with immune thrombocytopenic purpura

BACKGROUND: Immune thrombocytopenia (ITP) is an autoimmune disorder causing isolated thrombocytopenia. Monoclonal gammopathy of undetermined significance (MGUS) is an asymptomatic plasma cell disorder that may progress to multiple myeloma. The relationship between ITP, splenectomy, and MGUS development remains unclear. OBJECTIVES: This study aimed to investigate the association between splenectomy and MGUS development in adults with primary ITP and to evaluate long-term hematological changes after splenectomy. MATERIALS AND METHODS: This retrospective study included 94 adults with primary ITP followed for ≥3 years. Data were obtained from electronic medical records. Patients were categorized into splenectomized ( n = 35) and nonsplenectomized ( n = 59) groups. Hematological parameters and serum protein electrophoresis (SPE) were assessed. Statistical significance was set at P < 0.05. RESULTS: The cohort included 94 patients (mean age 45.9 years), 37.2% of whom underwent splenectomy. Comorbidities were present in 42.6%, most commonly diabetes mellitus and hypothyroidism, with no intergroup differences. Splenectomized patients had higher rates of ongoing treatment ( P = 0.001) and increased white blood cell, lymphocyte, monocyte, neutrophil ( P = 0.029), and platelet counts (PLTs) (all P ≤ 0.001). Although baseline PLTs were lower ( P = 0.001), final platelet levels were higher after splenectomy ( P = 0.001). The observed prevalence of MGUS was 1/94 (1.06%; 95% confidence interval = 0.19%–5.78%). Only one SPE-detected M-band occurred in a nonsplenectomized patient. CONCLUSIONS: Splenectomy was associated with sustained hematological changes, but MGUS prevalence was low. The study was underpowered to assess MGUS risk definitively. Larger prospective studies are needed.