Traditional laboratory measures of cardiovascular risk in hereditary spherocytosis

Abstract

Background Individuals who have undergone splenectomy may be at an increased risk of arterial and venous thrombosis. We sought to determine if splenectomy affects surrogate laboratory measures of cardiovascular risk in persons with hereditary spherocytosis (HS). Procedure We conducted a prospective cross-sectional study of 21 children and 36 adults with HS. Fasting blood samples were collected for complete blood count and plasma lipid panel, homocysteine, lipoprotein (a), C-reactive protein, and fibrinogen. The variables were compared between the groups with and without prior splenectomy by Mann–Whitney tests. Results Subjects with prior splenectomy had higher hemoglobin, white blood cell and platelet counts and lower reticulocyte counts and total serum bilirubin concentrations (P < 0.001). Subjects not having had splenectomy had lower than normal levels of total and LDL-cholesterol (LDL-C). Total and LDL-C values were significantly higher, as were fibrinogen and homocysteine concentrations, in the post-splenectomy subjects than in individuals with intact spleen. Conclusion Various lipid levels and other measures of cardiovascular risk are affected by splenectomy in persons with HS. Further investigations are indicated to more clearly define the balance of the potential benefits of hemolysis and anemia versus the deleterious effects of splenectomy in HS.

Clinical outcomes of splenectomy in children: Report of the splenectomy in congenital hemolytic anemia registry

“…For HS, all types of splenectomy resulted in control of clinical symptoms as well as improvement in hematologic laboratory parameters. Although our registry did not compare outcomes between PS and TS, both procedures had improved hematologic outcomes after surgery, a finding consistent with most previous literature [3, 4, 14, 18, 19]. A prospective randomized clinical trial will be required to definitively compare surgical procedures or surgical vs medical therapies.…”

Risk factors for thromboembolism and pulmonary artery hypertension following splenectomy in children with hereditary spherocytosis

“…Crary et al have reported reduced total cholesterol and LDL-C levels in patients with HS and an intact spleen. They found higher cholesterol levels in splenectomized patients, though within normal limits [26]. We did not observe an abnormal lipid profile in our patients.…”

“…Elevated fibrinogen predicts ischemic stroke and advanced atherosclerosis [34,35]. Crary et al [26] reported significantly raised fibrinogen [38]. However, none of our patients had elevated fibrinogen.…”

“…In a study of 20 splenectomized patients by Sedlacek et al CRP was significantly elevated in patients splenectomized for hematological indications as compared to post‐traumatic splenectomy ( P < 0.05). Crary et al reported higher CRP levels in 34 splenectomized patients with HS, as compared to 23 unsplenectomized patients, though the difference was not significant. We found CRP levels between 3 and 10 mg/L in eight (42%) patients.…”

“…Elevated fibrinogen predicts ischemic stroke and advanced atherosclerosis . Crary et al reported significantly raised fibrinogen levels in 23 splenectomized patients with HS, as against 34 conservatively managed patients. Kamisasa et al reported a significant rise in fibrinogen following splenectomy in cirrhotic patients.…”