Splenic Reticuloendothelial Function after Splenectomy, Spleen Repair, and Spleen Autotransplantation

Abstract

Overwhelming infection after splenectomy remains a problem despite the introduction of vaccine and antimicrobial prophylaxis. To evaluate prospectively various procedures proposed for salvage of the spleen, we measured reticuloendothelial function for two to five years in 51 patients who had initially presented with abdominal trauma and suspected splenic rupture. The mean percentage of pocked erythrocytes and the clearance of antibody-coated autologous erythrocytes in 8 patients who had splenic repair and in 6 who had partial splenectomy were the same as in 11 controls with intraabdominal injury that did not involve the spleen. The mean percentage of pocked erythrocytes remained significantly elevated in 19 patients who had undergone total splenectomy without autotransplantation of splenic tissue. One of seven patients who underwent splenic autotransplantation had a normal level of pocked erythrocytes 18 months after surgery, and a second patient had only a slight elevation at 24 months. The mean (+/- SEM) half-time clearance of labeled erythrocytes was significantly longer in the group that had total splenectomy without autotransplantation (421.1 +/- 74.5 hours) than in the autotransplantation group (91.6 +/- 20.0) or in the controls (5.4 +/- 2.0). We conclude that reticuloendothelial function was better preserved after partial splenectomy and splenic repair than after splenic autotransplantation, but that autotransplantation was superior to total splenectomy and appeared to be safe. Splenic autotransplantation deserves further study in patients who have had splenic trauma when other surgical maneuvers to save the spleen are not possible.

The Effects of Splenectomy and Autologous Spleen Transplantation on Complete Blood Count and Cell Morphology in a Porcine Model

“…However, total removal of the spleen may lead to side effects such as postsplenectomy infections and sepsis, due to the decreased production of antibodies and phagocytes or thrombosis, due to elevated platelet count in blood (Bessler et al, 2004;Khan et al, 2009;Miko et al, 2003;Timens & Leemans, 1992). Also, many studies report increased count of morphologically abnormal erythrocytes, immature red blood cells and pathologic erythrocyte inclusions in the peripheral blood of various species following splenectomy as a result of the loss of splenic filtrating function (Haklar et al, 1997;Resende et al, 2002;Traub et al, 1987). In addition, it has been reported that removal of the spleen causes significantly higher increase of reticulocyte count than other surgeries.…”

Outcome of Partial Splenectomy for Hypersplenism in Children with Thalassemia

“…So, autotransplantation or the preservation of splenenculi after total splenectomy has been practiced to prevent post splenectomy sepsis. [11][12] Total splenectomy has been practiced for a long time for palliation for thalassemic children. Conceivably it provides the best opportunity for palliation in thalassemic children by removing a substantial portion of reticuloendothelial system.…”

Splenosis and sepsis: The born-again spleen provides poor protection

“…For protection against infection, an intact spleen is better than a repaired or autotransplanted spleen, 93 while an accessory spleen and splenosis seem to be only slightly better than asplenia. Surgical or interventional radiologic techniques should be employed to maximize residual splenic tissues in cases of splenic injury.…”

“…Traub et al 93 studied splenic reticuloendothelial function after splenectomy, spleen repair and spleen autotransplantation. They showed that partial splenectomy and splenic repair were better than splenic autotransplantation in protecting against OPSI.…”