Therapeutic splenectomy in hematologic disorders. Effects and complications in 221 adult patients.

Abstract

. Two hundred and twenty-one adult patients were splenectomized for various hematologic disorders, including immunologic thrombocytopenia (80 cases), hereditary spherocytosis (15 cases), autoimmune hemolytic anemia (20 cases) chronic lymphatic leukemia (27 cases), lymphosarcoma (27 cases), myelofibrosis (11 cases) and pancytopenia/aplastic anemia (14 cases). Complete and lasting remission was achieved by 72 % of patients with immunologic thrombocytopenia and by 60% of patients with autoimmune hemolytic anemia. Improvement was seen in 74 % of patients with lymphosarcoma, in 55% of those with chronic lymphatic leukemia and in 63 % of those with myelofibrosis, whereas only one of 14 patients with pancytopenia/aplastic anemia had any benefit of splenectomy. Of 8 postoperative deaths (3.6 %), 6 were caused by septicemia and 2 by hemorrhage. Non-fatal complications, mainly infections and hemorrhages, occurred in 49 patients (22 %) and were most frequent in cases with massive splenomegaly (>1000 g) or severe thrombocytopenia (<20 × 109/l). Also, more complications occurred in chronic lymphatic leukemia and myelofibrosis than in other diseases. Late postsplenectomy fulminant infection was seen in 8 patients (3.6%), the type of infection being septicemia in 6 and meningitis in 2, and 6 of them died. We conclude that splenectomy is often of considerable benefit in the various hematologic disorders presently studied and sufficiently well tolerated to make it applicable as a therapeutic modality. The present results confirm the current view that splenectomy has little if any effect in patients with aplastic anemia.