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Defective spleen function in autoimmune gastrointestinal disorders

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Abstract

Defective spleen function increases susceptibility to bacterial infections which can be prevented by vaccine prophylaxis. Splenic hypofunction can be found in a number of autoimmune disorders; however, no data are available regarding autoimmune atrophic gastritis (AAG), autoimmune enteropathy (AIE) and autoimmune liver disease (AILD). Peripheral blood samples from patients with AAG (n = 40), AIE (n = 3) and AILD (n = 40) were collected. Patients affected by autoimmune disorders already known to be associated with splenic hypofunction, i.e. coeliac disease (CD) and ulcerative colitis (UC), were included as disease controls, while splenectomised patients and healthy subjects were evaluated as positive and negative controls, respectively. Counting of erythrocytes with membrane abnormalities, i.e. pitted red cells, was used as an indicator of spleen function (normal upper limit 4%). Defective splenic function was observed in 22 of the 40 patients with AAG (55.0%), in two of the three patients with AIE (66.6%) and in 35 of the 40 patients with AILD (87.5%). As expected, in untreated CD, refractory CD and UC there was a high prevalence of hyposplenism (43.7%, 88.2% and 54.4%, respectively). Due to the high prevalence of splenic hypofunction, patients with AAG, AILD and AIE should undergo pitted red cell evaluation and, if hyposplenic, they should be candidate to vaccine prophylaxis against encapsulated bacteria.

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Abbreviations

AAG:

Autoimmune atrophic gastritis

AIE:

Autoimmune enteropathy

AIH:

Autoimmune hepatitis

AILD:

Autoimmune liver disease

CD:

Coeliac disease

PBC:

Primary biliary cholangitis

PSC:

Primary sclerosing cholangitis

RCD:

Refractory coeliac disease

UC:

Ulcerative colitis

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Acknowledgements

The authors would like to thank all the subjects who agreed to give blood samples, without whom this study would not have been possible.

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Authors and Affiliations

  1. First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy

    Paolo Giuffrida, Nicola Aronico, Marco Vincenzo Lenti, Sara Cococcia, Mariangela Delliponti, Emanuela Miceli, Gino Roberto Corazza & Antonio Di Sabatino

  2. Institute for Liver and Digestive Health, Royal Free Hospital, University College London, London, UK

    Matteo Rosselli, Davide Roccarina, Francesca Saffioti, Douglas Thorburn & Massimo Pinzani

Authors
  1. Paolo Giuffrida
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  2. Nicola Aronico
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  3. Matteo Rosselli
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  4. Marco Vincenzo Lenti
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  5. Sara Cococcia
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  6. Davide Roccarina
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  7. Francesca Saffioti
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  8. Mariangela Delliponti
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  9. Douglas Thorburn
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  10. Emanuela Miceli
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  11. Gino Roberto Corazza
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  12. Massimo Pinzani
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  13. Antonio Di Sabatino
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Contributions

All authors participated in the drafting of the manuscript or critical revision of the manuscript for important intellectual content and provided approval of the final submitted version. Individual contributions are as follows. ADS: study concept and design, analysis and interpretation of data, manuscript preparation, principal investigator, and guarantor. PG, MVL: study concept and design, acquisition of data, technical and material support, manuscript preparation. NA: acquisition of data, technical and material support, manuscript preparation. SC and MD: acquisition of data, technical and material support. MR, DR, FS, DT and EM: clinical management of patients. GRC, MP, and ADS: study supervision.

Corresponding author

Correspondence to Antonio Di Sabatino.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Each patient provided informed consent to the study.

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Giuffrida, P., Aronico, N., Rosselli, M. et al. Defective spleen function in autoimmune gastrointestinal disorders. Intern Emerg Med 15, 225–229 (2020). https://doi.org/10.1007/s11739-019-02129-w

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  • DOI: https://doi.org/10.1007/s11739-019-02129-w

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