Splenectomy in Haematology Indications, Results, and Complications in 41 Cases

Abstract

The indications for, effect of, and immediate complications of splenectomy are reported on the basis of 41 patients followed for from 3 months to 3 years after the operation. There is a general indication for splenectomy in hereditary spherocytosis, but in other cases of haemolytic anaemia splenectomy appears to presuppose proof that the spleen is playing the main role in the erythrocyte sequestration. In chronic lymphatic leukaemia splenectomy may evidently be advised on the basis of fairly simple clinical findings: Disease activity that calls for treatment, e.g. weight loss, a tendency to sweating as well as anaemia, thrombocytopenia, combined with considerable splenomegaly as the predominant focus. The time of splenectomy should not be delayed as long as possible, as decisive items of risk appear to increase with the duration of the disease. For instance, pronounced splenomegaly gives rise to special problems, and long‐lasting cytostatic and corticoid medication as well as progression of the basic disease will increase the incidence of postoperative complications. Haemorrhage from the splenic bed and infection, most often with a pulmonary focus, were recorded as the most common operative complications. Their incidence was particularly high in operations on patients having chronic lymphatic leukaemia.

Splenectomy in Chronic Lymphocytic Leukaemia

“…An enlarged spleen contains an appreciable part (up to 90 %) of the circulating platelets in a splenic platelet pool, and splenectomy rapidly entails an increase in the platelet count which according to the present as well as previously published series (Christensen 1970(Christensen , 1971) seems to persist through a fairly long period (1 year or longer). As a rule, the frequency of major thrombocytopenia with attendant haemorrhagic diathesis is said to be slight in patients with CLL.…”

“…(c) The operative mortality is modest, if the operation is performed according to fixed lines in clolse collaboration between surgeon and haematologist. Incidentally, the operative mortality, according to a previous analysis, increases with increasing duration of the disease and exceeds 10 % in cases with appreciable splenomegaly (Christensen 1970).…”

“…Splenectomy for the treatment ol f patients with chronic lymphocytic leukaemia (CLL) characterised by splenomegaly was performed already before the turn of the century, and in 1921 the first promising results were published from the Mayo Clinic (Giffin 1921). Later, the effects of splenectomy, especially those at short sight, have been submitted in a number of clinical studies (Strumia et a1 1966, Hansen 1973, Christensen 1970,1971, Yam & Crosby 1974. Dramatic improvement has been observed, not only in cases with considerable hyperhaemolysis, usually due to autoimmunisation, but also in cases predominated merely by severe splenomegaly in whom there is but a low degree of hyperhaemolysis (Christensen 1971(Christensen , 1973.…”

“…The tendency to anaemia and thrombocytopenia is accentuated with increasing size of the spleen, and from a red-cell and platelet kinetic point of view there are obvious indications for splenectomy in cases charactensed by anaemiahhrombocytopenia and appreciable splenomegaly. Accordingly, selected patients with splenomegaly who undergo splenectomy invariably exhibit an increase of the haemoglobin level and platelet count lasting at least up to one year (Strumia et a1 1966, Hansen 1973, Christensen 1970, 1971.…”

Discussion

“…According to the present studies, hyperhaemolysis in patients with CLL and splenomegaly, but with a negative Coombs test, may be correlated to an increased 'normal physiological function' of the spleen following an increasing splenic erythrocyte pool. In patients with CLL splenectomy carries a high rate of operative complications (Strumia et al 1966, Egelund Christensen et al 1970, in particular if the spleen is very large, the disease is of long duration, and the patient has been on cytostatics and/or corticosteroids. Splenomegaly may be the initial manifestation in patients with CLL, but usually it occurs at a late stage of the disease.…”