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Splenectomy in systemic lupus erythematosus and autoimmune hematologic disease: a comparative analysis

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Abstract

The objective of the study is to analyze the efficacy and safety of splenectomy in the management of refractory autoimmune thrombocytopenia (AT)/autoimmune hemolytic anemia (AIHA) associated or not with systemic lupus erythematosus. Thirty-four patients after splenectomy due to severe AT and/or AIHA were divided into group 1 (G1) 18 SLE/APS patients: 9 AT/SLE patients, 6 SLE/antiphospholipid syndrome (APS), and 3 primary APS. Group 2 (G2): 16 patients without SLE/APS: 2 Fisher-Evans syndrome and 14 AIHA. Surgery approach when (1) platelets ≤ 50,000/ml despite 2 weeks on medical therapy, (2) medically dependent, and (3) medically intolerant or after two hemolytic crises in AIHA patients. Splenectomy response: (1) complete (CR): ≥ 150,000 platelets/ml, (2) partial: 50,000–149,000/ml, or (3) none: ≤ 50,000/ml. CR for AIHA: hemoglobin ≥9 g/dl. Statistical analysis: descriptive statistics and chi-square test. The mean age was 34.6 years; mean follow-up: 28.5 months. Open splenectomy in 15/34 vs laparoscopy in 19/34 (p = NS). CR in 15/34, G1: 4/18, G2: 11/16, (p = 0.006). Complications in 6/34, 5 from G2 vs 1 from G1 (p = 0.05). Relapse in 7/18 patients in G1 and 3/16 in G2 (p = 0.05). Open and laparoscopic splenectomies in SLE and AT patients are as effective as in those without SLE; however, patients with SLE and APS had more relapses.

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Acknowledgments

The authors thank to Dr. Bernal Humberto Esquinca Moreno for the kind supply of the spleen photograph.

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Authors and Affiliations

  1. Surgery Department, Hospital de Especialidades Centro Médico La Raza, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico

    Nahim Barron, Fernando González-Romero & José Arturo Velásques-García

  2. Education Division, Hospital de Especialidades Centro Médico La Raza, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico

    Jesús Arenas-Osuna

  3. Clinical Research Unit, Hospital de Especialidades Centro Médico La Raza, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico

    Gabriela Medina

  4. Research Division, Hospital de Especialidades Centro Médico La Raza, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico

    María Pilar Cruz-Dominguez

  5. General Direction, Hospital de Especialidades Centro Médico La Raza, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico

    Ernesto Alonso Ayala-López

  6. Direction of Education and Research, Hospital de Especialidades Centro Médico La Raza, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico

    Luis J. Jara

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  1. Nahim Barron
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Barron, N., Arenas-Osuna, J., Medina, G. et al. Splenectomy in systemic lupus erythematosus and autoimmune hematologic disease: a comparative analysis. Clin Rheumatol 37, 943–948 (2018). https://doi.org/10.1007/s10067-018-3979-4

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