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[Circulating immune complexes in chronic thrombocytopenic purpura in adults before and after splenectomy].

Circulating immune complexes (cic) were determined by means of the immunoenzymatic method in a group of 16 adults with immune thrombocytopenic purpura (ITP) before and after splenectomy. The recurrence of immune thrombocytopenic purpura after splenectomy was observed in 9 patients, in 6 out of them there co-existed non-specific inflammatory process and cic were present in the serum. In 7 patients in whom the number of thrombocytes after splenectomy was normal, no circulating immune complexes were found. A significant decrease in the medium level of IgM after splenectomy should be attributed rather to splenectomy than to the consuming of IgM in the formation of circulating complexes. The role of circulating complexes in the pathogenesis of ITP in adults still remains not fully solved, but the authors' experience suggests that non-specific inflammatory processes may lead to their appearance.

Adult↗

PubMed1989

[Indication for splenectomy in hemolytic anemias].

The role of splenectomy in the management of hemolytic anemias seems to be established. However, when we decide the indication of this procedure in individual patients, we should make the final judgement after evaluating the following items. The items to be discussed include 1) cause and mechanism of hemolysis, 2) predominant site of red cell destruction, 3) evaluation of splenomegaly, 4) the age of the patient and the time of splenectomy, 5) complications of splenectomy and their proper management, and 6) alternative treatments (including drug therapy) to splenectomy. After splenectomy, it is important to advise the patients and their families to seek immediate medical attention for febrile illnesses.

Adult↗

PubMed1989

Immune thrombocytopenia in hemophiliacs infected with human immunodeficiency virus and their response to splenectomy.

We studied five patients with hemophilia A in the age range of 18 to 64 years who were infected with human immunodeficiency virus and who developed immune thrombocytopenia. The clinical course of immune thrombocytopenia in relation to human immunodeficiency virus infection and the patients' responses to splenectomy and immune variables were determined. All five patients developed antibody to human immunodeficiency virus 6 to 60 months (median, 24 months) before the onset of thrombocytopenia, and two patients became human immunodeficiency virus antigenemic (one patient at the onset of immune thrombocytopenia and the other 60 months after the onset of immune thrombocytopenia [24 months after splenectomy]). All five patients had a strong platelet-associated immunoglobulin G and three patients also had a weak platelet-associated immunoglobulin M on their platelets. In four of five patients danazol therapy failed, and three patients required moderate doses of prednisone. Because of the progression of immune thrombocytopenia, four of the five patients underwent splenectomy with preoperative high-dose intravenous immune globulin. All four had an excellent immediate response to splenectomy, with a rise in platelet count to more than 300 x 10(9)/L and sustained remission during postsplenectomy follow-up of 6 to 45 months. There was no significant drop in CD4 and CD8 counts after splenectomy, and all four patients remained clinically well.

Adult↗

PubMed1988

Splenectomy for immune thrombocytopenia related to human immunodeficiency virus.

From 1 January 1984 to 31 August 1987, 11 patients underwent splenectomy for treatment of thrombocytopenia related to human immunodeficiency virus (HIV). Six of the patients had been previously treated with prednisone, five of whom showed some response. None of those who responded to the prednisone had a sustained response and, thus, all required splenectomy. All 11 patients had an excellent response to splenectomy. The average preoperative and postoperative platelet counts were 19,700 and 498,000, respectively. All patients have maintained normal platelet counts at an average follow-up period of 12.4 months (range of one to 37 months). There were no postoperative deaths. Morbidity was minimal; in two patients, wound seromas developed. In one patient, acquired immunodeficiency syndrome (AIDS) developed 12 months after splenectomy, but none of the other patients have evidence of AIDS. Splenectomy is a safe and effective therapy for HIV-related immune thrombocytopenia.

Acquired Immunodeficiency Syndrome↗

PubMed1977

A reappraisal of the role of splenectomy in children receiving renal allografts.

Four renal allograft recipients between 8 and 14 years of age died of acute fulminating infections less than 72 hours after the onset of symptoms. These patients all had undergone splenectomy at the time of related donor renal transplantation. Because the therapeutic value of splenectomy in renal transplantation has not been established, the role of adjunctive splenectomy is evaluated, and the relationship between splenectomy and overwhelming infection is discussed. As a result of these acute deaths in 4 of 62 children undergoing renal transplantation at this institution (6.4%), splenectomy in conjunction with renal transplantation in children has been discontinued.

Acute Disease↗

PubMed1987

Complications of splenectomy.

During the last three decades it has become clear that removal of the spleen, for any reason, is not a benign procedure. In both adults and children splenectomy places the patient at significantly higher risk of overwhelming infection, compared to the normal population. The risk of the post-splenectomy septic syndrome is lifelong and is not eliminated by the administration of polyvalent pneumococcal vaccine. Thus far, the reported rate of overwhelming sepsis in asplenic individuals has ranged from 2.5-13.5%. As more long-term follow-up data become available, it is likely that the true incidence will be 5-10%. In addition to this late complication, splenectomy increases the frequency of adverse events, including death, in the immediate postoperative period. Infections, particularly pulmonary and abdominal sepsis, constitute the majority of the complications. The mortality rate from postoperative sepsis is substantial. Atelectasis, pancreatitis/fistula, pulmonary embolism and bleeding at the operative site are also relatively common occurrences following splenic removal. These alarming statistics have spurred surgeons to change their attitudes concerning splenectomy for trauma, both accidental and iatrogenic. Nonoperative management of hemodynamically stable patients with isolated splenic injury and splenorrhaphy in patients requiring laparotomy are now firmly entrenched in the surgical armamentarium. Patients in whom splenectomy is necessary are given polyvalent pneumococcal vaccine and are instructed to seek early medical attention for febrile illnesses. Splenic autotransplantation and lifelong prophylactic antibiotic therapy have been used in some centers, but their clinical value remains to be proven.

Bacterial Infections↗

PubMed1987

Comparison of omental splenic autotransplant to partial splenectomy. Protective effect against septic death.

The possible benefit of either partial splenectomy or splenic autotransplantation as protection against post-splenectomy sepsis was investigated. Sprague-Dawley rats were challenged with intravenous Streptococcus pneumoniae and the incidence of bacteremia and mortality were recorded. Animals were divided into four groups based upon the amount of splenic tissue conserved: total splenectomy (0%), partial splenectomy (62%), splenic autotransplantation (27%), or sham celiotomy (100%). A statistically significant (P 0.05) decrease in the incidence of septic death was seen in comparing the total splenectomized animals (63%) to the autotransplant group (27%), the partial splenectomy (4%) and the control group (4%). This diminishing mortality is inversely proportional to the amount of splenic remnant in the respective groups. There was a similar, parallel relationship in the incidence of Streptococcus pneumoniae bacteremia. Thus, the greater the amount of remaining splenic tissue, the lower the incidence of bacteremia and subsequent mortality, implying the preservation of immunologic function with splenic conservation.

Animals↗

PubMed1986

Effect of splenectomy on acute inflammation.

It is becoming increasingly evident that platelets play a significant role in the inflammatory process. Heterogeneity has been demonstrated among platelets, and evidence has been presented that the spleen retains the youngest and hemostatically most effective platelets. The present study was designed to determine what effect splenectomy, by removing a special population of platelets, would have on acute inflammation as manifested by carrageenan-induced murine foot pad edema. Swiss white mice (25 +/- 2 g) were anesthetized and subjected to splenectomy (Group A, n = 13) or to celiotomy only (Group B, n = 15). One week later, carrageenan (0.1 cc of 1% solution) was injected into the right hind foot pad of each animal. The mice were killed 3.5 hr later, and both hind paws amputated at the tibio-tarsal joint and weighed individually. The change in weight of the experimental hind paw relative to control was expressed as edema index for each animal. The inflammatory reaction, as manifested by carrageenan edema, was significantly (P less than 0.001) decreased in those animals subjected to splenectomy. The mean edema index in Group A was 62.8 per cent compared to 80.9 per cent in Group B. The results of this study indicate that splenectomy decreases inflammation as manifested by carrageenan-induced edema. Splenectomy eliminates a population of platelets having greater functional capabilities than those found in the peripheral circulation and impairs the organism's ability to respond to injury.

Animals↗

PubMed1986

Splenectomy in systemic lupus erythematosis.

Of 860 patients with systemic lupus erythematosus (SLE) who were evaluated during a 25-year-period, 16 (1.9%) underwent splenectomy. Twelve of these patients had steroid resistant thrombocytopenia. An excellent long-term outcome occurred in eight (67%), significant improvement occurred in three (25%), and one patient died who also had chronic active hepatitis and portal hypertension. In two of three patients (67%) with autoimmune hemolytic anemia, the condition was corrected by splenectomy; in the third patient there was some improvement, but reduced doses of corticosteroids were required. One patient with severe neutropenia and recurrent bacterial infection obtained lasting benefit following splenectomy. Histologic examination of the removed spleen was not helpful in corroborating the diagnosis of SLE in these well established cases. Splenectomy had no adverse affect upon other aspects of SLE, in particular upon renal function. The authors conclude that the indications for splenectomy have proven to be of value in selected SLE patients with autoimmune or hypersplenic cytopenia.

Adolescent↗

PubMed1979

Effect of splenectomy alone and in combination with antilymphocyte serum on renal allograft rejection in the rat.

The effect of splenectomy alone and in combination with suboptimal doses of antilymphocyte serum (ALS) have been studied in the relatively weak (DA X Lewis)F1 to DA and the strong DA to Lewis renal allograft models. In the F1 to DA model, splenectomy alone produced a slight but significant prolongation of graft survival and in combination with a suboptimal dose of ALS gave excellent suppression of rejection. In the strong DA to Lewis model, splenectomy alone had no effect on graft survival and there were no additive effects with suboptimal doses of ALS. However, splenectomy alone produced a striking suppression of the lymphocytotoxic response to the kidney grafts in this combination. To elucidate the mechansim whereby splenectomy weakens the immune response, (DA X Lewis)F1 to DNA renal allografts were performed with the renal vein anastomosed to the recipient's portal vein. This procedure had no effect on graft survival.

Animals↗

PubMed1987

[Effect of splenectomy on cancers induced with ENNG (N-ethyl-N'-nitro-N-nitroso-guanidine) in the alimental canal].

The effect of splenectomy on cancers in the alimental canal induced with ENNG was investigated. Wistar rats were given 100 micrograms/ml ENNG in tap water ad libitum for four months. Splenectomy was carried out one month on group A (n = 19), two months on group B (n = 18), three months on group C (n = 19) and four months on group D (n = 16) after administration of ENNG. In the control group splenectomy was not performed and ENNG was only given. For the results, the size of tumors in group A and B rats were grossly reduced compared with group C and D rats. Histologically, epithelial tumors seemed to be differentiated in group A and B rats compared with those of group C and D rats. In the early stage when it was difficult to determine the tumors macroscopically and histologically, splenectomy seemed to inhibit the growth of alimental tumors induced with ENNG and splenectomy itself seemed to decrease the growth of alimental tumors induced with ENNG.

Animals↗

PubMed1985

[The role of the spleen in immunosuppression and the effects of splenectomy on prognosis in gastric cancer patients].

To elucidate the role of the spleen on the immunosuppression in gastric cancer patients, mechanism of the induction of suppressor cells in the spleen was investigated. Studies of tissue distribution of T cells using monoclonal antibodies revealed that spleen contained much higher proportion of OKT8 reactive T cells as compared with those in regional lymphnodes without metastasis. Lymphocytes released from the spleen during perfusion were taken to be representative of recirculating lymphocytes. Suppressor precursor cells were found to exist predominantly in perfusate from the spleen, while spontaneously activated suppressor cells were in the residual lymphocytes in the spleen after perfusion. Culture supernatants from splenic adherent cells induced suppressor cell activities as well as sera from splenic venous blood. These results suggest that suppressor precursor cells which could be mobilized slowly was more comparable to splenic lymphocytes and might be matured by factors released from splenic adherent cells, partly moving into peripheral blood. Furthermore, the effect of splenectomy on the prognosis of gastric cancer patients was investigated in randomized controlled trial. The patients who underwent total gastrectomy and had main location of the tumor on lesser curvature region were divided into two groups at random; splenectomy (+) and splenectomy (-) groups. A suggestive prolongation of survival time was observed in splenectomy (+) group. Thus, spleen seem to contribute to the immunosuppression in gastric cancer patients and splenectomy may lead to better prognosis.

Adult↗

PubMed1979

Effect of splenectomy on the immune response of BALB/c mice bearing an immunoglobulin M plasmacytoma (TEPC-183).

Mice bearing TEPC-183, an immunoglobulin M(kappa)-secreting plasmacytoma, exhibit severe suppression of their immune responses to both thymus-dependent and thymus-independent antigens, 2,4-dinitrophenyl, and the type 3 pneumococcal polysaccharide SSS-III. This immunosuppression is not lifted by splenectomy of the tumor-bearing mice or prevented by removal of the spleen prior to tumor injection. On the contrary, splenectomy either before or after tumor implantation further accentuates the immunosuppressed state of tumor bearers and even depresses the immune response of normal mice. A secondary immune response of normal mice 34 to 51 days after splenectomy is still reduced. Thus, spleen cells may play a dual role. While splenectomy may remove a source of suppressor cells in tumor-bearing mice, it also eliminates a major source of antibody-producing cells and results in reduced immune responses of normal and TEPC-183-bearing mice. These findings have clinical relevance since splenectomy is used as a therapeutic and diagnostic procedure in neoplastic lymphoproliferative disorders.

Animals↗

PubMed1979

Diagnostic and therapeutic aspects of splenectomy in syndromes associated with hypersplenia.

The value of splenectomy is assessed from diagnostic and therapeutic viewpoints in a series of 80 patients with various syndromes marked by hypersplenia. In the congestive type of splenomegaly, splenectomy resulted in complete normalization of the blood picture in all cases but one, and in primary splenic congestion it even proved curative in the majority of the cases. In leukaemia, non-Hodgkin's lymphomas, in myelofibrosis, and first of all in immuncytopenia, splenectomy was also of benefit, and had generally a palliative effect in non-autoimmune hypersplenia as well. In non-haematological syndromes associated with hypersplenia, namely, splenic tuberculosis, Boeck's sarcoid, SLE, haemorchromatosis and splenic vein thrombosis, splenectomy had generally a palliative, and combined with other therapeutic measures, a curative effect, depending on the primary disease. In a number of patients with hypersplenia associated with splenomegaly, it was only with the aid of splenectomy that the primary disease could be diagnosed.

Diagnosis, Differential↗

PubMed1977

Elective splenectomy in the elderly patient.

This report reviews 10 years' experience with elective splenectomy in patients over 55 years of age. Of 55 patients, 25 were over the age of 65. The majority of splenectomies (41) were performed for hematological disorders exclusive of lymphoma, but including ITP, hypersplenism (both primary and secondary), Felty's syndrome and myeloid metaplasia. Sixty-eight per cent of these patients responded to splenectomy with sustained elevation of platelet counts while 70 per cent responded to sustained elevation of leukocyte counts. Sixteen of the hematological patients received a preoperative trial of steroid therapy in an attempt to alleviate leukopenia or thrombocytopenia with a 37.5 per cent (6 of 16) success rate. There was no correlation between the response to preoperative steroid therapy and response to splenectomy. These data correspond favorably to previous published material in the younger aged patients. There was no difference in the postoperative complication rate related to drainage or nondrainage of the splenic bed. However, eight other complications occurred for a morbidity rate of 14.5 per cent in addition to complications related to drainage of the splenic bed (8%). A 9 per cent (5 of 55) mortality rate was related to the patients' pre-existing diseases and appears acceptable in light of hematological response rate and quoted mortality rates for splenectomy over age 65.

Age Factors↗

PubMed1979

Splenectomy for hematologic disease.

One hundred and thirty splenectomies were performed at the University Hospital in Birmingham for hematologic disorders during a 12 year period. There were seven deaths of which four were related to sepsis in patients with malignant growths which probably impaired immune competence. Splenectomy was found to be uniformly satisfactory for hereditary hemolytic anemia, for hypersplenism complicating rheumatoid arthritis and for the rare instance of primary hypersplenism. Splenectomy was usually salutary in didopathic thrombocytopenic purpura and in antoimmune hemolytic anemia. When done for diagnosis, splenectomy was definitive in about 50 per cent of the instances. Individual patients with thrombotic thrombocyeosinophilia syndrome benefited. Splenectomy for hypoplastic or aplastic anemia in an actual circulation offered only questionable benefit and is rarely necessary for hyperplenism secondary to portal hypertension.

Adult↗

PubMed1978

Immune thrombocytolytic purpura (ITP): a diagnostic and therapeutic survey of 86 cases with regard to the results of splenectomy and conservative therapy.

The therapeutic results in 86 cases of ITP seen over a period of 15 years are reported. Distribution of the haemorrhagic manifestations was in agreement with published data. On follow-up of the 40 splenectomized patients, the shortened platelet life-span, the reduced "recovery" as well as the increased rates of platelet turnover and platelet formation revealed a manifest tendency of normalization. One year after splenectomy the results were found "good" or "moderate" in 86%, more than two years after the intervention in 85%, of the cases. Retrospective analysis of the platelet-sequestration studies having shown "good" or satisfactory results in 93% of the splenic cases, this investigation is regarded as crucial to the indication of splenectomy. The absence of increased thrombocytopoiesis in approximately 15% of the cases is attributed to an antibody effect, reflected in a reduced polyploidy of the megakaryocytes. Normalization or increase in platelet count early after splenectomy is interpreted as a favourable prognostic sign. On the other hand, neither age of the patients nor the time of splenectomy was found to affect the success of the intervention. The results of corticosteroid treatment (Prednisolon 52%) lag far behind those of splenectomy. Ten patients were given combined immunosuppressive treatment.

Adolescent↗

PubMed1983

[Anemia of kidney failure treated by periodical hemodialysis. III. The effect of splenectomy. A retrospective study of 25 cases].

Twenty-five patients with severe renal impairment treated by periodical haemodialysis underwent splenectomy (for spleen injury or tuberculosis in 2). All have been on long-term follow-up. At present, 7 patients have not improved; 7 are no longer transfused but remain anaemic with a less than 20% haematocrit; 11 have a more than 20% haematocrit without transfusion. Statistical analysis of the data shows that splenectomy, when effective, acts by reducing excess plasma volume and excessive haemolysis. Red cell production is not increased. The beneficial effect of splenectomy cannot be predicted from age, sex, cause of renal impairment or severity of anaemia. However, in this series there was a positive correlation between the degree of haemolysis, the site of red cell sequestration, the size of the spleen and the effectiveness of splenectomy. Infection, notably septicaemia in grafted (and immunodepressed) patients is a major risk of splenectomy and requires preventive measures.

Anemia↗