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01-04-2018 | Original Article

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

Authors: Nahim Barron, Jesús Arenas-Osuna, Gabriela Medina, María Pilar Cruz-Dominguez, Fernando González-Romero, José Arturo Velásques-García, Ernesto Alonso Ayala-López, Luis J. Jara

Published in: Clinical Rheumatology | Issue 4/2018

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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Title: Splenectomy in systemic lupus erythematosus and autoimmune hematologic disease: a comparative analysis
Authors: Nahim Barron
Jesús Arenas-Osuna
Gabriela Medina
María Pilar Cruz-Dominguez
Fernando González-Romero
José Arturo Velásques-García
Ernesto Alonso Ayala-López
Luis J. Jara
Publication date: 01-04-2018
Publisher: Springer London
Published in: Clinical Rheumatology / Issue 4/2018
Print ISSN: 0770-3198
Electronic ISSN: 1434-9949
DOI: https://doi.org/10.1007/s10067-018-3979-4

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