Our Summary

This study examined medical records from the Cleveland Clinic Foundation between 2002 and 2020, looking at 1,824 adults who had their spleen removed. This procedure, known as a splenectomy, is often used to treat immune-related blood disorders. The study found that the procedure was most commonly used for patients with immune thrombocytopenic purpura (a disorder that results in easy or excessive bruising and bleeding) and autoimmune hemolytic anemia (a disorder where the immune system destroys red blood cells faster than it can produce them).

The average age of the patients was 55, and they typically had the procedure 11 months after their diagnosis. The procedure was successful for 74% of the patients, but 12% did experience a relapse. A different diagnosis after the surgery was found in 13% of the patients and these patients also had a higher chance of relapse. Surgery-related complications occurred in 12% of cases, while only 3% of patients died from disease complications.

The study found that the procedure was less likely to be successful for patients who had already tried three or more types of drug treatments. However, patients aged 40 or under or those with a primary diagnosis of immune thrombocytopenic purpura or an isolated low platelet count were more likely to respond well to the procedure.

In conclusion, the study found that removing the spleen can be an effective treatment for immune-related blood disorders, with a relatively low risk of complications.

FAQs

  1. What is the most common indication for splenectomy according to the Cleveland Clinic Foundation study?
  2. What preoperative factors were found to be associated with splenectomy treatment failure?
  3. What were the hematologic response rates to splenectomy in the study of adult patients with immune cytopenias?

Doctor’s Tip

A doctor might tell a patient undergoing splenectomy to follow up closely with their healthcare provider and adhere to any prescribed post-operative care, such as taking antibiotics to prevent infection or getting vaccinations to protect against certain illnesses. They may also advise the patient to avoid contact sports or activities that could potentially lead to injury to the spleen area. Additionally, the doctor may recommend regular blood tests to monitor for any changes in blood cell counts and to assess the effectiveness of the splenectomy in treating their immune-mediated cytopenia.

Suitable For

Patients who are typically recommended for splenectomy include those with immune thrombocytopenic purpura (ITP), autoimmune hemolytic anemia, and other immune-mediated cytopenias who have failed to respond to multiple lines of pharmacologic treatment. Isolated thrombocytopenia, primary ITP, and younger age (≤40 years) are factors associated with a higher likelihood of response to splenectomy. Patients with discordant diagnoses or who have undergone multiple lines of medical therapy prior to splenectomy may have a higher risk of treatment failure. Overall, splenectomy is shown to be an effective treatment option for immune-mediated cytopenias with a low complication rate.

Timeline

Before splenectomy, a patient typically experiences symptoms such as immune-mediated cytopenia, which may include thrombocytopenia, anemia, and neutropenia. These symptoms may be refractory to pharmacologic treatments, leading to the decision to undergo splenectomy. The patient may undergo various lines of medical therapy before the decision for surgery is made.

After splenectomy, the patient may experience hematologic response, with improvement in their cytopenia symptoms. The most common indications for splenectomy are immune thrombocytopenic purpura (ITP) and autoimmune hemolytic anemia. The median age of patients undergoing splenectomy is 55 years, with a median time from diagnosis to surgery of 11 months. Hematologic response rates are reported to be 74% overall, with a 12% relapse rate. Surgery-related complications occur in 12% of cases, while the mortality rate from disease complications is 3%.

Preoperative factors associated with response to splenectomy include isolated thrombocytopenia, primary ITP, and age ≤40 years. Patients who have undergone multiple lines of pharmacologic treatment prior to surgery are more likely to experience treatment failure post-splenectomy.

In conclusion, splenectomy is shown to be an effective treatment option for immune-mediated cytopenias with a low complication rate, but response to the procedure may vary based on preoperative factors.

What to Ask Your Doctor

  1. What specific immune-mediated cytopenia do I have that is requiring a splenectomy?
  2. What are the potential risks and complications associated with splenectomy?
  3. What is the success rate of splenectomy in treating my condition?
  4. How long is the recovery process after splenectomy?
  5. Are there any alternative treatment options to consider before proceeding with splenectomy?
  6. Will I need any additional medications or treatments after the procedure?
  7. How often will I need follow-up appointments to monitor my condition post-surgery?
  8. Are there any lifestyle changes or precautions I should take after splenectomy?
  9. What is the long-term outlook for my condition after undergoing splenectomy?
  10. Are there any specific factors or preoperative considerations that may affect my response to splenectomy?

Reference

Authors: Ogbue OD, Bahaj W, Kewan T, Ahmed R, Dima D, Willimas N, Durmaz A, Visconte V, Maskal SM, Gurnari C, Steven R, Maciejewski JP. Journal: J Intern Med. 2024 Feb;295(2):229-241. doi: 10.1111/joim.13742. Epub 2023 Nov 13. PMID: 37953670