Our Summary

This research paper discusses the use of splenectomy, or the removal of the spleen, as a treatment for a variety of blood disorders, both benign (non-cancerous) and malignant (cancerous). The paper also explores how the development of less invasive surgical methods, like laparoscopy, and new treatments like monoclonal antibody therapy, have changed when and how splenectomy is used.

While the use of splenectomy has evolved, it still has a role in treating certain blood disorders. For example, it can be beneficial for patients with abnormal hemoglobin conditions and diseases that cause the destruction of red blood cells. It can also help improve low platelet count in patients who haven’t responded to other treatments, can alleviate symptoms related to an enlarged spleen due to a condition called myelofibrosis, or it can be used for diagnosis or treatment of an enlarged spleen in lymph-related diseases.

FAQs

  1. What are the main indications for elective splenectomy in hematological disorders?
  2. How has the advent of minimally invasive approaches and monoclonal antibody therapy changed the indications and outcomes of splenectomy for hematologic disease?
  3. What are some of the conditions that can be improved or reversed through splenectomy?

Doctor’s Tip

A helpful tip a doctor might tell a patient about splenectomy is to make sure to stay up to date on vaccinations, especially for encapsulated bacteria such as Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis. Since the spleen plays a crucial role in the body’s immune system, patients who have undergone splenectomy are at an increased risk for infections from these bacteria. It is important to discuss with your healthcare provider about getting vaccinated to help prevent these potentially serious infections.

Suitable For

Patients who are typically recommended for splenectomy include those with:

  1. Hemoglobinopathies such as thalassemia and sickle cell disease, where splenectomy can help improve symptoms and complications associated with these conditions.
  2. Hemolytic diseases such as hereditary spherocytosis or autoimmune hemolytic anemia, where splenectomy can help reduce the destruction of red blood cells.
  3. Refractory immune thrombocytopenic purpura, where splenectomy can improve thrombocytopenia that is not responsive to other treatments.
  4. Myelofibrosis with voluminous splenomegaly, where splenectomy can help alleviate symptoms and complications associated with an enlarged spleen.
  5. Lymphoproliferative syndromes, where splenectomy may be used for diagnostic purposes or to treat complications related to splenomegaly.
  6. Myeloproliferative syndromes, where splenectomy may be considered as part of the treatment plan.

Overall, splenectomy is typically recommended for patients with hematological disorders that are not responsive to other treatments or for those who experience severe symptoms or complications related to their condition.

Timeline

Before splenectomy:

  1. Patient presents with symptoms such as anemia, thrombocytopenia, or recurrent infections.
  2. Patient undergoes diagnostic tests such as blood tests, imaging studies, and possibly a bone marrow biopsy to determine the underlying hematological disorder.
  3. After a definitive diagnosis is made, the patient and healthcare team discuss treatment options, including the possibility of splenectomy.
  4. Patient undergoes preoperative evaluation and preparation for surgery, which may include vaccinations to prevent infections post-splenectomy.

After splenectomy:

  1. Patient undergoes splenectomy surgery, which can be performed traditionally through open surgery or laparoscopically.
  2. Patient is monitored closely postoperatively for any complications such as bleeding, infection, or blood clots.
  3. Patient receives education on the importance of lifelong antibiotic prophylaxis and vaccinations to prevent infections, particularly encapsulated bacteria such as Streptococcus pneumoniae.
  4. Patient may experience improvements in symptoms such as anemia, thrombocytopenia, or recurrent infections post-splenectomy.
  5. Patient continues to be monitored regularly by their healthcare team to assess for any long-term complications of splenectomy, such as an increased risk of certain infections or thrombotic events.

What to Ask Your Doctor

  1. What are the potential risks and complications of splenectomy?
  2. How will my immune system be affected by having my spleen removed?
  3. What is the recovery process like after a splenectomy?
  4. Will I need any special vaccinations or medications after the surgery?
  5. How will my overall health and quality of life be impacted by having my spleen removed?
  6. Are there alternative treatment options to consider before resorting to splenectomy?
  7. How long will I need to stay in the hospital after the surgery?
  8. What follow-up care will be necessary after the splenectomy?
  9. Will I need to make any lifestyle changes or adjustments after the surgery?
  10. What is the long-term outlook for someone who has undergone a splenectomy?

Reference

Authors: Bonnet S, Guédon A, Ribeil JA, Suarez F, Tamburini J, Gaujoux S. Journal: J Visc Surg. 2017 Dec;154(6):421-429. doi: 10.1016/j.jviscsurg.2017.06.011. Epub 2017 Jul 27. PMID: 28757383