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Journal of Veterinary Internal Medicine Jul 2022Current reports about the use of splenectomy for the management of immune-mediated hemolytic anemia (IMHA) or immune-mediated thrombocytopenia (ITP) or both in dogs are...
BACKGROUND
Current reports about the use of splenectomy for the management of immune-mediated hemolytic anemia (IMHA) or immune-mediated thrombocytopenia (ITP) or both in dogs are limited.
OBJECTIVES
To retrospectively describe the use of splenectomy as part of the management for IMHA, ITP, and concurrent IMHA and severe thrombocytopenia (CIST) in dogs. It was hypothesized that splenectomy would be beneficial in allowing for reduction of dose of immunosuppressive drugs or discontinuation in 1 or more of these groups.
ANIMALS
Seventeen client-owned dogs (7 with IMHA, 7 with ITP, and 3 with CIST) were identified across 7 UK-based referral hospitals from a study period of 2005 to 2016.
METHODS
Data were collected retrospectively via questionnaires and included information about diagnosis, management and treatment response before and after splenectomy. Based on clinical outcome, treatment with splenectomy as part of the management protocol was classified as either successful or unsuccessful.
RESULTS
Six of 7 dogs with ITP were managed successfully with splenectomy as part of their management protocol (3 complete and 3 partial responses), although 1 subsequently developed suspected IMHA. Of the 7 dogs with IMHA, splenectomy was part of a successful management protocol in 4 dogs (2 complete and 2 partial responses). In the CIST group, 1 case (1/3) responded completely to management with splenectomy as part of the management protocol.
CONCLUSIONS AND CLINICAL IMPORTANCE
Splenectomy was considered successful and well tolerated in most cases of isolated ITP. Whether there is a benefit of splenectomy in cases of IMHA and CIST could not be determined in the current study.
Topics: Anemia, Hemolytic, Autoimmune; Animals; Dog Diseases; Dogs; Retrospective Studies; Splenectomy; Thrombocytopenia
PubMed: 35801263
DOI: 10.1111/jvim.16469 -
Haematologica Aug 2017Hereditary hemolytic anemias are a group of disorders with a variety of causes, including red cell membrane defects, red blood cell enzyme disorders, congenital...
Hereditary hemolytic anemias are a group of disorders with a variety of causes, including red cell membrane defects, red blood cell enzyme disorders, congenital dyserythropoietic anemias, thalassemia syndromes and hemoglobinopathies. As damaged red blood cells passing through the red pulp of the spleen are removed by splenic macrophages, splenectomy is one possible therapeutic approach to the management of severely affected patients. However, except for hereditary spherocytosis for which the effectiveness of splenectomy has been well documented, the efficacy of splenectomy in other anemias within this group has yet to be determined and there are concerns regarding short- and long-term infectious and thrombotic complications. In light of the priorities identified by the European Hematology Association Roadmap we generated specific recommendations for each disorder, except thalassemia syndromes for which there are other, recent guidelines. Our recommendations are intended to enable clinicians to achieve better informed decisions on disease management by splenectomy, on the type of splenectomy and the possible consequences. As no randomized clinical trials, case control or cohort studies regarding splenectomy in these disorders were found in the literature, recommendations for each disease were based on expert opinion and were subsequently critically revised and modified by the Splenectomy in Rare Anemias Study Group, which includes hematologists caring for both adults and children.
Topics: Anemia, Hemolytic, Congenital; Guidelines as Topic; Humans; Splenectomy; Thrombosis
PubMed: 28550188
DOI: 10.3324/haematol.2016.161166 -
International Journal of Surgery... 2013The spleen has been considered for millennia a fascinating and mysterious organ with multiple functions. The spleen has long been an organ of interest in popular as well... (Review)
Review
BACKGROUND
The spleen has been considered for millennia a fascinating and mysterious organ with multiple functions. The spleen has long been an organ of interest in popular as well as medical literature.
METHODS
A literature (Pubmed) and historical review about splenectomy has been performed.
RESULTS
The importance of spleen and the related surgical procedure of splenectomy has been an important topic of scientific interest since the Ancient Greece culture to more modern times.
CONCLUSIONS
Spleen and splenectomy have important roles in the medical literature and popular tradition. Nowadays laparoscopic splenectomy is increasingly popular and for certain indications it is considered the gold standard therapy.
Topics: History, 16th Century; History, 17th Century; History, 19th Century; History, 20th Century; History, 21st Century; Humans; Spleen; Splenectomy
PubMed: 24380550
DOI: 10.1016/S1743-9191(13)60013-8 -
International Journal of Surgery... 2014Splenectomy is a powerful therapeutic procedure in a wide variety of medical disorders provided that it is not undertaken lightly and the risks are weighed against the... (Review)
Review
UNLABELLED
Splenectomy is a powerful therapeutic procedure in a wide variety of medical disorders provided that it is not undertaken lightly and the risks are weighed against the potential benefits in each individual case. Most of this risk seems to be due to the underlying splenectomy indication and not to splenectomy alone. There has been an increased tendency in recent years towards splenic preservation to prevent not only the risk of subsequent overwhelming post-splenectomy infection (OPSI) but the long term risk of cardiovascular complications. As there is no condition that can be cured by splenectomy, this paper reviewed the rationale behind the indications for, and the associated risks.
METHOD
Electronic searches of the medline (PubMed) database, Cochrane library, and science citation index were performed to identify original published studies on splenectomy. Relevant articles were searched from relevant chapters in specialized texts and all included.
Topics: Humans; Postoperative Complications; Risk Assessment; Splenectomy
PubMed: 24316283
DOI: 10.1016/j.ijsu.2013.11.017 -
Langenbeck's Archives of Surgery Sep 2022Postoperative pancreatic fistula (POPF) is a complication discussed in the context of pancreatic surgery, but may also result from splenectomy; a relationship that has...
PURPOSE
Postoperative pancreatic fistula (POPF) is a complication discussed in the context of pancreatic surgery, but may also result from splenectomy; a relationship that has not been investigated extensively yet.
METHODS
This retrospective single-center study aimed to analyze incidence of and risk factors for POPF after splenectomy. Patient characteristics included demographic data, surgical procedure, and intra- and postoperative complications. POPF was defined according to the International Study Group on Pancreatic Surgery as POPF of grade B and C or biochemical leak (BL).
RESULTS
Over ten years, 247 patients were identified, of whom 163 underwent primary (spleen-associated pathologies) and 84 secondary (extrasplenic oncological or technical reasons) splenectomy. Thirty-six patients (14.6%) developed POPF of grade B/C or BL, of which 13 occurred after primary (7.9%) and 23 after secondary splenectomy (27.3%). Of these, 25 (69.4%) were BL, 7 (19.4%) POPF of grade B and 4 (11.1%) POPF of grade C. BL were treated conservatively while three patients with POPF of grade B required interventional procedures and 4 with POPF of grade C required surgery. POPF and BL was noted significantly more often after secondary splenectomy and longer procedures. Multivariate analysis confirmed secondary splenectomy and use of energy-based devices as independent risk factors for development of POPF/BL after splenectomy.
CONCLUSION
With an incidence of 4.5%, POPF is a relevant complication after splenectomy. The main risk factor identified was secondary splenectomy. Although POPF and BL can usually be treated conservatively, it should be emphasized when obtaining patients' informed consent and treated at centers with experience in pancreatic surgery.
Topics: Humans; Incidence; Pancreatic Fistula; Pancreaticoduodenectomy; Postoperative Complications; Retrospective Studies; Risk Factors; Splenectomy
PubMed: 35508768
DOI: 10.1007/s00423-022-02531-7 -
Langenbeck's Archives of Surgery Jun 2022The spleen provides a unique immune function in its production of opsins directed against encapsulated bacteria. Splenectomy, therefore, increases the risk of infections...
INTRODUCTION
The spleen provides a unique immune function in its production of opsins directed against encapsulated bacteria. Splenectomy, therefore, increases the risk of infections in patients as well as post-operative complications. This study aims to assess the risk of post-operative complications within 5 years of splenectomy by indication for splenectomy: trauma, disease, or in association with a distal pancreatectomy for pancreatic disease. The relationship between vaccination and infectious outcomes was also investigated.
METHODS
This study is a review of splenectomy cases between June 2005 and June 2015 at a single institution. Infection, splenectomy indication, and vaccination history were identified from electronic medical records and lab test confirmations. Data was analyzed using Student's t test for continuous variables, the Mann-Whitney U test for ordinal variables, and a Chi-square/Fisher exact test for categorical variables.
RESULTS
A total of 106 splenectomy patients were included: 35 traumatic (74% male) and 71 non-traumatic causes (42% male) with no significant difference in age. There were no statistical differences in complications during splenectomy and vaccination administration between the splenectomy indication groups: trauma, disease, and with distal pancreatectomy. There was a statistically significant higher infection rate within 5 years post-splenectomy in the non-traumatic vs traumatic group (42% vs 14.0%, p = 0.0040) with majority gastrointestinal (7/38) and respiratory (5/38) and surgical wound infections (3/38) observed in non-traumatic versus traumatic, respectively.
CONCLUSION
Results from data analysis show a statistically significant difference in rates of infection within 5 years post-operatively between traumatic versus non-traumatic indications for splenectomies, with the non-traumatic group experiencing a higher rate of infectious outcomes. The non-traumatic group included patients with disease and distal pancreatectomy indications. This suggests that patients who have non-traumatic causes may be at a higher risk of developing infections following splenectomy procedure. Additionally, vaccinations did not appear to have a protective effect.
Topics: Female; Humans; Male; Pancreatectomy; Pancreatic Diseases; Postoperative Complications; Retrospective Studies; Spleen; Splenectomy
PubMed: 35075620
DOI: 10.1007/s00423-022-02446-3 -
Clinical Lymphoma, Myeloma & Leukemia Sep 2020Splenomegaly, which may range from a few centimeters below the left costal border to massive dimensions, is one of the most characteristic features in patients with... (Review)
Review
Splenomegaly, which may range from a few centimeters below the left costal border to massive dimensions, is one of the most characteristic features in patients with advanced myelofibrosis (MF). Splenectomy may offer an effective therapeutic option for treating massive splenomegaly in patients with MF, and especially in cases of disease refractory to conventional drugs, but it is associated with a number of complications as well as substantial morbidity and mortality. Whether splenectomy should be performed before allogeneic hematopoietic stem-cell transplantation is also controversial, and there is a lack of prospective randomized clinical trials that assess the role of splenectomy before hematopoietic stem-cell transplantation in patients with MF. Although splenectomy is not routinely performed before transplantation, it may be appropriate in patients with massive splenomegaly and related symptoms, so long as the higher risk of graft failure in such cases is taken into account. This review aims to describe the efficacy, indications, and complications of splenectomy in patients with MF; and to evaluate the long-term impact of splenectomy on patient survival and risk of disease transformation.
Topics: Female; Hematopoietic Stem Cell Transplantation; Humans; Male; Primary Myelofibrosis; Splenectomy; Transplantation Conditioning; Treatment Outcome
PubMed: 32482540
DOI: 10.1016/j.clml.2020.04.015 -
Journal of Visceral Surgery Dec 2017Splenectomy is part of the therapeutic arsenal for benign or malignant hematological disorders that constitute the main indication for elective splenectomy. With the... (Review)
Review
Splenectomy is part of the therapeutic arsenal for benign or malignant hematological disorders that constitute the main indication for elective splenectomy. With the development of minimally invasive approaches, and in particular, laparoscopy, as well as the advent of monoclonal antibody therapy, the indications and the outcomes of splenectomy for hematologic disease have changed in recent years. Nonetheless, splenectomy has its place in hemoglobinopathies and hemolytic diseases, improves thrombocytopenia in refractory immune thrombocytopenic purpura, can reverse sequelae linked to voluminous splenomegaly secondary to myelofibrosis, or can be used for diagnostic purposes or for splenomegaly in lymphoproliferative syndromes.
Topics: Female; Hematologic Diseases; Humans; Laparoscopy; Male; Prognosis; Severity of Illness Index; Splenectomy; Splenomegaly; Treatment Outcome
PubMed: 28757383
DOI: 10.1016/j.jviscsurg.2017.06.011 -
Haematologica Dec 2023In children with sickle cell anemia (SCA), early splenic complications can require splenectomy, but the benefit-to-risk ratio and the age at which splenectomy may be...
In children with sickle cell anemia (SCA), early splenic complications can require splenectomy, but the benefit-to-risk ratio and the age at which splenectomy may be safely performed remain unclear. To address this question, we analyzed the rate of post-splenectomy events in children with SCA splenectomized between 2000-2018 at the Robert Debré University Hospital, Paris, France. A total of 188 children underwent splenectomy, including 101 (11.9%) from our newborn cohort and 87 referred to our center. Median (Q1-Q3) age at splenectomy was 4.1 years (range 2.5-7.3 years), with 123 (65.4%) and 65 (34.6%) children splenectomized at ≥3 years of age or <3 years of age, respectively. Median postsplenectomy follow-up was 5.9 years (range 2.7-9.2 years) yielding 1192.6 patient-years (PY) of observation. Indications for splenectomy were mainly acute splenic sequestration (101 [53.7%]) and hypersplenism (75 [39.9%]). All patients received penicillin prophylaxis; 98.3% received 23-valent polysaccharic pneumococcal (PPV-23) vaccination, and 91.9% a median number of 4 (range 3-4) pneumococcal conjugate vaccine shots prior to splenectomy. Overall incidence of invasive bacterial infection and thrombo-embolic events were 0.005 / PY (no pneumococcal infections) and 0.003 / PY, respectively, regardless of age at splenectomy. There was an increased proportion of children with cerebral vasculopathy in children splenectomized <3 years of age (0.037 / PY vs. 0.011 / PY; P<0.01). A significantly greater proportion of splenectomized than non-splenectomized children were treated with hydroxycarbamide (77.2% vs. 50.1%; P<0.01), suggesting a more severe phenotype in children who present spleen complications. If indicated, splenectomy should not be delayed in children, provided recommended pneumococcal prophylaxis is available. Spleen complications in childhood may serve as a marker of severity.
Topics: Infant, Newborn; Child; Humans; Child, Preschool; Splenectomy; Spleen; Bacterial Infections; Anemia, Sickle Cell; Streptococcus pneumoniae
PubMed: 37226714
DOI: 10.3324/haematol.2022.282556 -
Annals of the Royal College of Surgeons... Mar 2019The aim of this study was to review the experience of general surgeons performing splenectomy in a district general hospital. The outcomes are discussed together with...
INTRODUCTION
The aim of this study was to review the experience of general surgeons performing splenectomy in a district general hospital. The outcomes are discussed together with potential reasons for the increasing rarity of the procedure.
METHODS
A retrospective cohort study was carried out of all patients undergoing splenectomy (as identified by a single trust pathology department on receipt of splenic samples) between 1 January 2000 and 1 May 2017. Case notes and computer systems were interrogated for data on operating surgeon, patient demographics, diagnosis, surgical approach (laparoscopic/open/converted to open), critical care admission and 30-day mortality.
RESULTS
During the study period, 170 consecutive splenectomies were undertaken by 24 different operating surgeons. There were on average 5.8 planned and 4.2 unplanned splenectomies per year. The 30-day mortality rate for all splenectomies was 8.8%, with an elective 30-day mortality rate of 2.0%. Only 3 of the current consultant surgeons had undertaken more than 6 cases over the 17-year study period. Some senior consultants had not performed any splenectomies (either planned or unplanned) during the 17-year study period.
CONCLUSIONS
Splenectomy is required ever more rarely and experience as a district general hospital consultant is limited. Possible reasons for this include improvements in medical management of haematological diseases, the increasing use of conservative and radiological management for traumatic splenic injury, and a reduction in trauma cases and diversion of such cases to major trauma centres. Trainees and consultants must seek experience during specialty training or via cadaveric training in order to demonstrate competence.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Elective Surgical Procedures; Emergency Treatment; Female; Hospital Mortality; Hospitals, General; Humans; Laparoscopy; Male; Middle Aged; Retrospective Studies; Spleen; Splenectomy; Splenic Rupture; Surgeons; Young Adult
PubMed: 30602286
DOI: 10.1308/rcsann.2018.0215