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- Title
Splenectomy in systemic lupus erythematosus and autoimmune hematologic disease: a comparative analysis.
- Authors
Barron, Nahim; Arenas-Osuna, Jesús; Medina, Gabriela; Cruz-Dominguez, María Pilar; González-Romero, Fernando; Velásques-García, José Arturo; Ayala-López, Ernesto Alonso; Jara, Luis J.
- Abstract
The objective of the study is to analyze the efficacy and safety of splenectomy in the management of refractory autoimmune thrombocytopenia (AT)/autoimmune hemolytic anemia (AIHA) associated or not with systemic lupus erythematosus. Thirty-four patients after splenectomy due to severe AT and/or AIHA were divided into group 1 (G1) 18 SLE/APS patients: 9 AT/SLE patients, 6 SLE/antiphospholipid syndrome (APS), and 3 primary APS. Group 2 (G2): 16 patients without SLE/APS: 2 Fisher-Evans syndrome and 14 AIHA. Surgery approach when (1) platelets ≤ 50,000/ml despite 2 weeks on medical therapy, (2) medically dependent, and (3) medically intolerant or after two hemolytic crises in AIHA patients. Splenectomy response: (1) complete (CR): ≥ 150,000 platelets/ml, (2) partial: 50,000-149,000/ml, or (3) none: ≤ 50,000/ml. CR for AIHA: hemoglobin ≥9 g/dl. Statistical analysis: descriptive statistics and chi-square test. The mean age was 34.6 years; mean follow-up: 28.5 months. Open splenectomy in 15/34 vs laparoscopy in 19/34 (<italic>p</italic> = NS). CR in 15/34, G1: 4/18, G2: 11/16, (<italic>p</italic> = 0.006). Complications in 6/34, 5 from G2 vs 1 from G1 (<italic>p</italic> = 0.05). Relapse in 7/18 patients in G1 and 3/16 in G2 (<italic>p</italic> = 0.05). Open and laparoscopic splenectomies in SLE and AT patients are as effective as in those without SLE; however, patients with SLE and APS had more relapses.
- Subjects
SPLENECTOMY; SYSTEMIC lupus erythematosus; IDIOPATHIC thrombocytopenic purpura; HEMOLYTIC anemia; SURGICAL complications; COMPARATIVE studies; PATIENTS; THERAPEUTICS
- Publication
Clinical Rheumatology, 2018, Vol 37, Issue 4, p943
- ISSN
0770-3198
- Publication type
Article
- DOI
10.1007/s10067-018-3979-4