In older children, however, splenectomy is recommended if the child has been treated for 12 months without improvement, if the ITP is very severe or is getting worse, or if the child begins to bleed into the head or brain.
If platelet levels do not improve within one to four months, or high doses of prednisone are required, splenectomy may be recommended.
Splenectomy is usually avoided in children younger than five years because of the increased risk of a severe postoperative infection.
Splenectomy can result in an increase and hemolytic anemia can result in a decrease in glycated hemoglobin.
If the patient is an adolescent female with extremely heavy periods, splenectomy may also be recommended.