Our Summary
This research paper examines the effects of removing the spleen (splenectomy) on patients who have suffered traumatic brain injuries (TBI). After a brain injury, the blood tends to clot less effectively immediately (hypocoagulability), then too much in the following days (hypercoagulability), and there’s a constant risk of clot-related complications (thromboembolic events). Previous research has shown that patients with moderate or severe brain injuries who also have their spleen removed have a higher chance of dying. The researchers believe this might be due to the spleen’s removal making the blood clotting problems worse and increasing activity in the platelets, the cells responsible for forming clots.
They tested this hypothesis using mice, who had either a brain injury and spleen removal, just a brain injury, or just spleen removal. They took blood samples at various intervals after the injuries to see how the blood clotting and platelet activity changed.
They found that mice with both a brain injury and spleen removal had a slower clotting time 6 hours after injury, suggesting they had a higher risk of bleeding. By 24 hours later, these mice had faster clotting times, suggesting a higher risk of forming dangerous clots, despite having fewer platelets contributing to the clot. This fast clotting time continued even 7 days after the injury.
In terms of platelet activity, mice with both injuries had higher levels of an indicator called P-selectin 1 hour after injury, but by 24 hours, mice with just a brain injury had higher levels. However, only in mice with both injuries did this indicator stay elevated 7 days after injury.
In conclusion, spleen removal after a brain injury seems to make blood clotting problems worse, which could explain why patients with both injuries are more likely to die. The findings suggest initial bleeding risk is increased, followed by a longer period of increased clotting risk and platelet activity.
FAQs
- How does splenectomy following TBI impact the coagulation state of the body?
- Does splenectomy increase the risk of mortality in patients with TBI?
- How does TBI/splenectomy affect platelet activation compared to TBI alone?
Doctor’s Tip
A doctor might tell a patient who has undergone a splenectomy that they are at an increased risk for developing coagulation abnormalities, both hypo- and hypercoagulable states. It is important for the patient to be vigilant about any signs of abnormal bleeding or clotting and to seek medical attention if they experience any unusual symptoms. Regular follow-up appointments and monitoring of coagulation parameters may be necessary to ensure optimal management of their condition.
Suitable For
Patients who have sustained traumatic brain injury (TBI) and are at risk for intracranial bleeding are typically recommended splenectomy if they have concurrent splenic injuries. However, this study suggests that splenectomy following TBI may exacerbate changes in the post-injury coagulation state, leading to adverse effects such as acute hypocoagulability and subacute hypercoagulability. Therefore, careful consideration should be given to the potential risks and benefits of splenectomy in TBI patients, especially in those with combined brain and splenic injuries.
Timeline
Before splenectomy, a patient may experience symptoms related to the underlying condition necessitating the surgery, such as an enlarged spleen, blood disorders, or trauma. The patient would undergo pre-operative evaluations, including blood tests, imaging studies, and consultations with specialists.
After splenectomy, the patient may experience pain and discomfort at the surgical site, which can be managed with pain medications. There is an increased risk of infection, particularly from encapsulated bacteria, due to the role of the spleen in the immune system. Therefore, patients are often advised to receive vaccinations and take antibiotics as a preventive measure. Patients may also require ongoing monitoring of blood counts to detect any changes in platelet levels or coagulation status.
Overall, the timeline of events before and after splenectomy involves pre-operative evaluations, surgery, post-operative care, and long-term management of potential complications.
What to Ask Your Doctor
- How will a splenectomy affect my risk for thromboembolic events following traumatic brain injury?
- What changes in my coagulation and platelet activation levels should I expect after a splenectomy?
- Will I need to take any medications or undergo any additional treatments to manage the effects of a splenectomy on my coagulation system?
- How long will it take for my body to adjust to the changes in my coagulation system after a splenectomy?
- Are there any specific lifestyle changes I should make to reduce my risk for complications related to my coagulation system after a splenectomy?
- What signs or symptoms should I watch for that may indicate a potential issue with my coagulation system after a splenectomy?
- Are there any additional precautions I should take when participating in physical activities or sports after a splenectomy, considering the effects on my coagulation system?
- How often should I follow up with you or another healthcare provider to monitor the effects of my splenectomy on my coagulation system?
Reference
Authors: Morris MC, John D, Singer KE, Moran R, McGlone E, Veile R, Goetzman HS, Makley AT, Caldwell CC, Goodman MD. Journal: Thromb Res. 2020 Sep;193:211-217. doi: 10.1016/j.thromres.2020.08.002. Epub 2020 Aug 7. PMID: 32798961