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PubMed1980

Splenic artery embolization prior to splenectomy in end-stage polycythemia vera.

A patient with polycythemia rubra vera and myeloid metaplasia required splenectomy because of local symptoms attributable to a massively enlarged spleen. Preoperative embolization of the splenic circulation with inert materials was performed to reduce splenic size and vascularity in order to permit safe splenectomy. This case illustrates the utility of preoperative splenic embolization when routine splenectomy is contraindicated for technical reasons. The hazards of this technique and guidelines for its clinical use are outlined.

Aged↗
PubMed1985

Spleen irradiation in chronic lymphocytic leukemia (CLL): palliation in patients unfit for splenectomy.

In 22 patients with CLL given 30 courses of spleen irradiation, 23 responses were observed (77%, 95% confidence limits, 58-90%). Response was defined as reduction in palpable spleen size accompanied by relief of symptoms (pain, abdominal discomfort, and sweating) or improvement in hypersequestration or hemolytic anemia. Reduction in leukocyte count alone was not regarded as response. All responses were partial. The median response duration was 1 year. Subsequently, three patients underwent splenectomy. The median survival from the beginning of spleen irradiation was 2.5 years (range: 1 month-greater than 5 years). Only six patients had minor side effects from the gastrointestinal tract. The hematologic effect was most pronounced on the white blood cell count, but also the platelet count was affected. It is concluded that spleen irradiation is a gentle and effective alternative in CLL patients suffering from splenomegaly (pain and hypersplenism), refractory to chemotherapy and glucocorticosteroids and unfit for splenectomy. Splenic irradiation may also be used with benefit preoperatively before splenectomy in patients with excessive splenomegaly and hypersplenism.

Adult↗
PubMed1985

Thrombotic thrombocytopenic purpura: recovery after splenectomy associated with persistence of abnormally large von Willebrand factor multimers.

A patient with thrombotic thrombocytopenic purpura (TTP) responded transiently to four courses of plasma exchange therapy, then subsequently had a sustained completed remission following splenectomy. The von Willebrand factor multimeric pattern during remission following each plasma exchange and during the entire postsplenectomy period showed abnormally large forms that were not present on presentation and with each clinical relapse. These findings support prior observations regarding the presence of abnormal von Willebrand factor multimers in relapsing TTP and suggest that the multimers contribute to platelet aggregation and the thrombotic lesions. The association of sustained remission and persistence of the abnormally large plasma multimers after splenectomy suggests that this response was not coincidental. This supports the concept that a subgroup of patients with TTP may exist in which the pathophysiology of disease is significantly modulated by the spleen and in which splenectomy may induce long-lasting remission.

Blood Coagulation Factors↗
PubMed1987

Pocked erythrocyte counts in patients with hereditary spherocytosis before and after splenectomy.

The pocked (pitted or vacuolated) erythrocyte count has become increasingly utilized as a simple inexpensive test of splenic reticuloendothelial function. Values are less than 2.0% in normal subjects and 20 to 70% following splenectomy. Because scant and conflicting data are available about pocked erythrocyte measurements in hemolytic anemias other than the hemoglobinopathies, we performed pocked erythrocyte counts in 27 patients with hereditary spherocytosis. Prior to splenectomy patients often had elevated values (mean 4.9%). This unexpected observation suggests that hemolytic anemia may result in congestion of the red pulp and/or induced mild splenic reticuloendothelial blockade. As expected, but contrary to a previous report, pocked erythrocyte values following splenectomy were markedly increased (mean 54.9%).

Adolescent↗
PubMed1992

Role of splenectomy in the management of hemophilic patients with human immunodeficiency virus-associated immunopathic thrombocytopenic purpura.

Immunopathic thrombocytopenic purpura (ITP) can be a life-threatening complication of human immunodeficiency virus (HIV) infection in patients with hemophilia and can seriously compromise quality of life if not managed effectively. We report here complete response to splenectomy in four severe hemophiliacs with HIV-associated ITP. All patients were symptomatic, had platelet counts less than 25,000/mm3, and had failed at least one non-surgical therapy prior to splenectomy. All patients tolerated surgery well and obtained an immediate and durable complete response. In addition to our experience, a review of the literature shows that splenectomy is well tolerated and provides the most effective long-term solution for hemophiliacs with HIV-ITP.

Adolescent↗
PubMed1979

Splenectomy for undiagnosed splenomegaly.

During the 9-year period 1968-76 116 splenectomies were performed at the General Hospital, Nottingham. Of these, 13 (11 per cent) were undertaken for unexplained splenomegaly. In 6 patients a diagnosis was established by the operative procedure (2 with sarcoidosis, 2 splenic cysts, 1 Gaucher's disease and 1 haemangiosarcoma). Histological examination of the excised spleens in the remaining 7 patients showed no specific features. Two of these patients benefited considerably from removal of very large spleens. Another patient died from lymphosarcoma which was diagnosed 21 months after splenectomy. In the remaining 4 patients with mild to moderate splenomegaly, there were no real diagnostic or therapeutic advantages. It is concluded that splenectomy should always be considered in patients with unexplained moderate or gross splenomegaly but it may not be helpful in the patient whose spleen is only midly enlarged.

Adolescent↗
PubMed1981

Splenectomy for hypersplenism in malignant lymphomas.

Splenectomy has been performed in advanced malignant lymphomas in an effect to correct haematological cytopaenias in 41 patients since 1975. In both Hodgkin's disease and a variety of non-Hodgkin's lymphomas the operation has been associated with a high percentage of haematological correction (90 per cent overall). In many of these patients the haematological defect had prevented or led to the cessation of treatment and in those cases where chemotherapy was resumed after splenectomy worthwhile remission was achieved in 87.5 per cent of patients. There was no postoperative deaths and morbidity was considered acceptably low. We conclude that splenectomy is a valuable adjunct to treatment in advanced malignant lymphomas and should be considered at the first suggestion of splenic overactivity and reduced bone marrow reserves.

Adolescent↗
PubMed1981

Thrombotic risks of staging laparotomy with splenectomy in Hodgkin's disease.

No significant excess of deep vein thrombosis (DVT) as measured by the 125I-labelled fibrinogen method was observed in patients having staging laparotomy and splenectomy for Hodgkin's disease (HD) compared with patients having elective cholecystectomy under highly standardized surgical conditions. Patients who did have DVT all had splenic involvement with HD. There was no correlation between the post-splenectomy thrombocytosis and the occurrence of DVT. Patients with non-Hodgkin's lymphoma (NHL) and splenomegaly had a high incidence of DVT after splenectomy.

Adult↗
PubMed1986

Early postoperative course following elective splenectomy in haematological diseases: a high complication rate in patients with myeloproliferative disorders.

One hundred and sixty-seven patients subjected to splenectomy on haematological indications were studied. They were grouped into five diagnostic categories: auto-immune disorders (52 patients), Hodgkin's disease (32) lymphoproliferative malignancies (60), myeloproliferative malignancies (18) and miscellaneous (5). The total number of complications and deaths were 42 (25 per cent) and nine (5 per cent), respectively. Infections were the most common complication, occurring in 30 cases and accounting for 59 per cent of all sequelae. Patients with auto-immune disorders had a high frequency of subphrenic left-sided abscesses (5/52). Splenectomy for Hodgkin's disease was associated with a very low frequency of complications. In the 60 patients with lymphoproliferative malignancies left-sided pneumonia was common (9/60). Complications occurred in 56 per cent of the patients with myeloproliferative disorders, the associated mortality rate being 28 per cent. It is concluded that elective splenectomy in haematological diseases seems to be a safe procedure in most patients with the exception of individuals with myeloproliferative malignancies. The high operative risk in this group makes the benefit questionable. In patients with auto-immune disorders the high frequency of subphrenic abscesses indicates that prophylactic antibiotic treatment should be considered.

Adolescent↗
PubMed1988

Splenectomy and renal allograft survival in the rat.

The effect of splenectomy on renal allograft survival is not clear. In the rat, spleens isolated from recipients with functioning grafts have been shown to be a major source of cells that are capable of suppressing the rejection response (suppressor T lymphocytes). Thus the removal of the spleen in these allograft recipients could be detrimental to renal allograft survival. This study investigates this hypothesis, and looks for the presence of suppressor cells in other lymphoid organs apart from the spleen. In the rat renal allograft model, donor Lewis spleen cells given to DA recipients intravenously 1 week before transplantation of a Lewis kidney leads to indefinite allograft survival (median survival time (MST) greater than 100 days). Splenectomy before or after pretreatment with donor spleen cells failed to abrogate this effect (MST greater than 100 days). Experiments were performed in which cells or serum were prepared from long-term surviving splenectomized animals which had already been pretreated and transplanted, and then were injected into untreated recipients (adoptive transfer experiments). This was done to determine if cells capable of suppressing graft rejection were present in lymphoid organs outside the spleen in these splenectomized recipients. Thus the IV transfer of 10(8) lymph node cells harvested from splenectomized DA recipients with a long-term surviving LEW graft (LTS), into untreated but lightly irradiated (200 rad) DA recipients resulted in indefinite survival of a fresh Lewis kidney (MST greater than 100 days). In contrast, adoptive transfer of normal DA lymph node cells was ineffective (MST 13 days). Thus splenectomy is not necessarily detrimental to graft survival, as cells capable of preventing graft rejection are found in other lymphoid organs, such as lymph nodes, in splenectomized recipients.

Animals↗
PubMed1991

Role of splenectomy as a salvage procedure in thrombotic thrombocytopenic purpura.

Thrombotic thrombocytopenic purpura is a rare but serious haematological disease for which first-line therapy is medical, but not always successful. The role of splenectomy in the management of such patients is unclear. This paper reports three patients with the condition who went into remission following splenectomy after other forms of therapy had failed. Because thrombotic thrombocytopenic purpura is nearly always fatal if a remission is not obtained, splenectomy should be considered in patients who prove to be resistant to medical therapy.

Adult↗
PubMed1993

Splenectomy for splenomegaly exceeding 1000 grams: analysis of 47 patients.

Forty-seven patients who underwent splenectomy for splenomegaly > or = 1000 g were studied retrospectively. There were 29 men and 18 women of mean age 56 (range 19-87) years. Haematological malignancy was the most common disorder (42 patients). The main indications for splenectomy were cytopenia (20 patients), diagnosis (14), initial treatment of leukaemia (eight), pain (four) and spontaneous rupture (one). Thirteen patients underwent an associated surgical procedure. One patient died (mortality rate 2 per cent) and 12 (26 per cent) had postoperative complications. The advantages of splenectomy included histopathological diagnosis in 13 of 14 patients with splenomegaly of unknown origin, effective initial treatment in prolymphocytic and hairy cell leukaemia, definitive relief of pain in all affected patients, and long-term improvement of cytopenia in most.

Adult↗
PubMed1994

Laparoscopic splenectomy for idiopathic thrombocytopenic purpura.

Laparoscopic splenectomy was performed on eight patients with idiopathic thrombocytopenic purpura refractory to medical treatment. Preoperative infusion of immunoglobulin G gamma-globulin was used to boost the platelet count. Accessory spleens were sought by preoperative computed tomography and peroperative examination of the usual anatomical locations. Seven patients underwent successful laparoscopic splenectomy, with a mean postoperative stay of 3.6 days. One patient with an accessory spleen detected before operation but not during laparoscopy required conversion to open surgery for control of haemorrhage from the splenic hilum. Another patient had a transient pancreatic fistula. Laparoscopic splenectomy is feasible and sfe in patients with idiopathic thrombocytopenic purpura. Long-term results require evaluation as detection of accessory spleens can prove difficult during laparoscopy.

Adolescent↗
PubMed1983

Experimental study on merits and demerits of splenectomy in tumor bearers.

Immunologic merits and demerits of splenectomy were studied using a rat's experimental tumor. When splenectomy was done on day - 14, 2, or 14 of tumor inoculation, subsequent tumor growth was inhibited, but when it was done on day 7, tumor enhancement was observed. On day 2, cpm values of phytohemagglutinin (PHA)-induced blastogenesis of splenocytes was lower than in normal rats, on day 7 they significantly increased as compared with day 2, and on day 14 they significantly decreased as compared with day 7. Stimulation index (SI) ratio of PHA-induced blastogenesis and natural cell-mediated killing (NK) activity were also investigated using splenocytes, thymocytes, and peripheral lymphocytes. The results indicated that immunological competency of splenocytes of tumor bearers was reduced in the early, late, and final tumor-bearing periods, while it was increased in the middle tumor-bearing period. Tumor growth following splenectomy was considered to be controlled by these changes in immunological competency of splenocytes.

Adenocarcinoma↗
PubMed1987

Effect of splenectomy on treatment of Lewis lung carcinoma by an immunomodulatory polysaccharide and a cytotoxic agent.

The effect of the spleen on the efficiency of chemotherapy (cyclophosphamide) and immunotherapy (the polysaccharide levan) of C57BL mice bearing the Lewis lung carcinoma was studied. The development of Lewis lung carcinoma caused a gradual splenomegaly in the C57BL mice. Splenectomy did not, however, affect tumor growth in the nontreated host. Levan induced a pronounced splenomegaly. Splenectomy reduced markedly the antitumoral effect of the polysaccharide. These results indicate that spleen elements participate in the inhibitory activity of levan. By contrast, splenectomy had no effect on the efficiency of treatment of cyclophosphamide.

Adjuvants, Immunologic↗
PubMed2006

ABO-mismatch adult living donor liver transplantation using antigen-specific immunoadsorption and quadruple immunosuppression without splenectomy.

ABO-incompatible (ABO-I) liver transplantation is a controversial issue because of the generally less favorable outcome as compared to compatible transplants. Encouraging results have been shown by the introduction of new strategies to reduce posttransplant-specific hemagglutinin (HA) titers with plasmapheresis, reinforced immunosuppression (IS), and the use of splenectomy. We describe a new protocol consisting of daclizumab (DAC) induction, mycophenolate mofetil (MMF)/tacrolimus (TAC)/steroids without splenectomy. Five recipients (mean age of 47 +/- 14 yr) undergoing ABO-I living donor liver transplantation (LDLT) were included in this protocol. Immunoadsorbent columns (Glycosorb ABO) were used for antigen-specific immunoadsorption (ASI). The median follow-up was 18.5 +/- 10.5 months. ASI was very efficient in lowering HA titers (mean log(2) immunoglobulin [Ig] M [IgM] and IgG values before and after ASI were 5.9 +/- 2.8 and 1.2 +/- 1.4 [P= 0.0038] and 6.5 +/- 2.3 and 1.1+/- 1.9, respectively [P= 0.0001]). Persisting low HA titers were observed over time. No sepsis nor cytomegalovirus infection episodes were recorded. Acute cellular rejection (ACR) occurred in 1 recipient responding to steroid pulse therapy. Two grafts were lost in 2 patients due to technical failure during the first postoperative month. We conclude that ASI using Glycosorb ABO, quadruple immunosuppression including DAC and MMF provide high efficiency to lower HA titers over time, avoiding the need for splenectomy. ABO-I LDLT can be performed with this adapted IS protocol.

ABO Blood-Group System↗
PubMed2006

Hemorheological follow-up after splenectomy and spleen autotransplantation in mice.

We previously reported on a spleen autotransplantation model in mice, with spleen function studies at 6 weeks. The present study was undertaken to investigate long-term hemorheological functions. A/J and BALB/c inbred mice were divided into four groups: control, sham surgery (SH), splenectomy (SE), and spleen autotransplantation (AU). Hematological and hemorheological parameters were determined. Leukocyte counts in the SE and AU groups were significantly higher than in controls, while hematocrit levels were markedly lower. Mean erythrocyte volume did not change significantly. Platelet counts in the AU group were significantly lower, and red blood cell deformability was significantly worse in the SE group. The AU group also had increased cell transit time, but it was less than that in the SE group. The SE group showed the highest fibrinogen levels. We conclude that there are some consistent differences in hematological parameters between splenectomy and spleen autotransplantation. These data suggest that spleen autotransplantation may partially restore hemorheological functions following splenectomy.

Animals↗
PubMed1984

Splenectomy after angiographic embolization of the splenic artery in patients with massive splenomegaly and severe thrombocytopenia, in juvenile subacute myelomonocytic leukemia.

Splenectomy for massive splenomegaly in thrombocytopenic patients refractory to platelet transfusions carries increased surgical risks. Blocking of the splenic artery may reduce the size of the organ, prolong the survival of transfused platelets, and reduce the surgical complications. We describe four cases of extreme splenomegaly and thrombocytopenia where successful splenectomy was carried out after angiographic embolization of the splenic artery in children with juvenile chronic myelogenous leukemia. Significant improvement was observed in platelet counts and in the survival of platelets after transfusions in three of the patients. There was a concomitant decrease in transfusion requirements. Isoimmunization prevented prolonged platelet survival in the fourth case. We recommend earlier splenectomy in these patients to reduce transfusion requirements and delay the onset of poor platelet survival after transfusions.

Blood Transfusion↗