Indications for and results of splenectomy in different hematological disorders

Abstract

The objective of this retrospective study was to determine the indications for splenectomy in hematological disorders and to analyze the results depending on the indication leading to surgery. Fifty-six patients with various hematological disorders were splenectomized between 1990 and 1994. The main indication was noted. Operative success was defined as: return to normal platelet counts without further medication in thrombocytopenia, relief of pain and local compression syndrome in painful splenomegaly, hemoglobin levels > 10 g/dl without the need for further transfusions in hemolytic anemia, response to chemotherapy after splenectomy for prior resistance because of massive splenic infiltration, and relief of infection in splenic infection. Morbidity and mortality were noted. Five major indications for splenectomy were found: thrombocytopenia (n = 36, success 78%), painful splenomegaly (n = 8, success 100%), hemolytic anemia (n = 5, success 60%), resistance to chemotherapy because of massive splenic infiltration (n = 5, success 100%). One patient with thrombocytopenia died (mortality 2%). Seven patients had major complications (13%). In hematological diseases, thrombocytopenia, painful splenomegaly and splenic infection are likely to be improved by splenectomy. In hemolytic anemia it can be a helpful approach, while in resistance to chemotherapy because of massive splenic infiltration success is less likely.

Surgical and anaesthetic outcomes of paediatric splenectomies at a tertiary care institution in South India: a retrospective cohort

“…A signi cant proportion of splenectomised patients achieve long-term control of their disease with minimal morbidity and mortality [1,3,8,9]. In keeping with current literature, our study too yielded impressive overall survival rates with 98%.…”

“…Transfusion related complications like iron overload and its effects on various organs, risk of blood borne infections and related cost of healthcare only adds to this nancial burden. Splenectomy affords symptomatic relief and can reduce transfusion dependency in many [3][4][5][6][7], but is not without its risks, hence is considered as a therapeutic option only when absolutely necessary and the bene ts outweigh the risks.…”

Comparative response to splenectomy in coombs-positive autoimmune hemolytic anemia with or without associated disease

“…The investigators from Germany recently reported the results of splenectomy in various hematological conditions, which were comparable to the literature with response rates of 60% and 78% in patients with AHA and thrombocytopenia, respectively [11]. These studies, however, failed to compare the results in idiopathic cases versus those with associated diseases.…”

Invited commentary to: „Laparoscopic splenectomy in 26 patients — A 17-months follow-up study“

“…The authors of the present study chose the latter. Platelet counts above 100,000 of steroids should be achieved in 75 to 80% of patients with ITP (1,3). In the present series (8), 9 of 15 (60%) patients with ITP met this criteria, whereas 3 still required steroids and 3 others were failures.…”