Asplenia and spleen hypofunction

Lenti, Marco Vincenzo; Luu, Sarah; Carsetti, Rita; Osier, Faith; Ogwang, Rodney; Nnodu, Obiageli; Wiedermann, Ursula; Spencer, Jo; Locatelli, Franco; Corazza, Gino Roberto

doi:10.1038/s41572-022-00399-x

Cited by 27 publications

(36 citation statements)

References 198 publications

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“…Actually, in near‐total splenectomy with the smallest remnant after the procedure, the assessment of pitted erythrocytes showed a remarkably high percentage of pitE up to values usually observed after TS in a substantial number of patients 30 . In contrast, in the largest cohort of ‘classic’ open STS with a remnant volume around 30 mL or higher all examined patients presented with normal pitE 27,31 . In our cohort, almost half of the LSTS patients presented normal (<2%) or borderline (2%–4%) pitE values, and none of the patients had pitE >15% indicating severe hyposplenia 23 .…”

Section: Discussionmentioning

confidence: 42%

Long‐term haematological response and maintained immunological function after laparoscopic subtotal splenectomy in patients with hereditary spherocytosis

Münch,

Jacobsen,

Schulz

et al. 2023

European J of Haematology

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IntroductionSubtotal or total splenectomy are recommended in severe and should be considered in intermediate forms of hereditary spherocytosis (HS). Data on laparoscopic subtotal splenectomy (LSTS) in HS patients are sparse.MethodsThirty three patients with HS (median age 10.7 years (yrs), range 1.8–15.5) underwent LSTS. Baseline and follow‐up investigation included haematological parameters, microscopic analysis of pitted erythrocytes (pitE), and B‐cell subpopulations assessed by flow cytometry. Results were compared to those of non‐splenectomised HS patients, HS patients after total splenectomy (TS), and healthy individuals.ResultsAfter LSTS, haemoglobin levels were normalised in all patients. During median long‐term follow‐up of 3.9 yrs (range 1.1–14.9), only four patients presented mild anaemia. Despite re‐growing of the remnant spleen none of the patients required a second surgical intervention. As compared to TS, PitE in LSTS patients were significantly lower and indicated normal to only moderately decreased spleen function. Relative but not absolute IgM memory B‐cell counts were reduced in both LSTS and TS patients.ConclusionsLSTS is effective for the treatment of patients with HS. A small remnant spleen is sufficient to provide adequate phagocytic function and to induce a pool of IgM memory B‐cells.

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Section: Discussionmentioning

confidence: 42%

Long‐term haematological response and maintained immunological function after laparoscopic subtotal splenectomy in patients with hereditary spherocytosis

Münch,

Jacobsen,

Schulz

et al. 2023

European J of Haematology

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“…In the spleen, there are mainly two regions: 1, red pulp, composed of splenic sinusoids and pulp cords that form a filtering structural entity; 2, white pulp, containing the immune cells and surrounded by the red pulp (Figure 4C). [ 3,24 ] As shown in Figure 4D, the NIR‐II fluorescence exhibits a speckled network indicating the red pulp region. Mass spectrometry image of the section monitored at m/z 895.2 also displays the similar distribution of VIX‐S in red pulp (Figure 4E).…”

Section: Resultsmentioning

confidence: 98%

“…[ 2 ] Morphological observation of the spleen is essential for splenic diseases such as splenomegaly, splenic cyst, and splenic injury. [ 3 ] Clinically, computed tomography (CT) has been widely used for visualizing the spleen. [ 4 ] However, there are still intense demands of innovatively low‐cost and pragmatic techniques for imaging the spleen, especially in biomedical research.…”

Section: Introductionmentioning

confidence: 99%

Specific Spleen‐Accumulated NIR‐II Fluorescent Probe for Imaging‐Guided Splenic Operation

Yang

Liu

et al. 2023

Adv Healthcare Materials

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Spleen is a large immune organ in the body. Splenic operations such as splenectomy and intrasplenic injection are of paramount importance for immunological research and splenic diseases. Fluorescence imaging can vastly simplify these operations, but a specific spleen‐targeting probe is still unavailable. Herein, the first specific spleen‐accumulated fluorescent probe, VIX‐S is reported, which fluoresces at 1064 nm and is highly stable. Systematic studies reveal the superior targeting and imaging performance of VIX‐S for the spleen in both nude and haired mice. In vivo imaging indicates that the probe can image the morphology of spleen with a signal‐background ratio of at least two‐fold higher than that of the liver. Moreover, the application of VIX‐S in imaging‐guided splenic operation, including splenic injury and intrasplenic injection, is demonstrated, which may provide a practice tool for spleen research in the animal model.

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“…Cytopaenias secondary to excessive bone marrow infiltration or other extrasplenic manifestations may remain after the surgery. Furthermore, asplenic patients’ lifelong risks of septic infections of encapsulated organisms, particularly pneumococci, are only partially mitigated by appropriate vaccinations [14]. Asplenia is also considered a risk factor in COVID‐19, now an endemic disease, and some countries have prioritized asplenic patients for vaccinations [15, 16].…”

Section: Introductionmentioning

confidence: 99%

“…Splenectomy is preferable from a diagnostic perspective and gives a rapid relief of symptoms (i.e., abdominal discomfort and cytopaenias related to splenic sequestration) [13]. However, perioperative complications may occur (i.e., infections, bleeding and thrombosis), and patients with splenic marginal zone lymphoma are often elderly and at risk for surgical complications [14]. Cytopaenias secondary to excessive bone marrow infiltration or other extrasplenic manifestations may remain after the surgery.…”

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confidence: 99%

Splenic marginal zone lymphoma in Sweden 2000–2020: Increasing rituximab use and better survival in the elderly

Junlén,

Sonnevi,

Lindén

et al. 2023

eJHaem

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The treatment of splenic marginal zone lymphoma is debated: splenectomy (the old standard‐of‐care) is better than chemotherapy but maybe not better than rituximab‐containing treatment. We examined all 358 patients diagnosed with splenic marginal zone lymphoma in Sweden 2000–2020. The median overall survival was 11.0 years. The median age was 73 years; 61% were women. Age was the only independently prognostic clinical characteristic. Eighty‐six patients were started on wait‐and‐watch, 90 rituximab monotherapy, 47 rituximab‐chemotherapy, 88 splenectomy, 37 chemotherapy, and 10 both systemic therapy and splenectomy. Overall survival was inferior in patients treated with chemotherapy, but equal in patients treated with rituximab, rituximab‐chemotherapy and splenectomy. Patients treated with both systemic therapy and splenectomy showed good outcome, suggesting that surgery can be safely reserved for nonresponders. After adjustment for age, survival did not differ between patients started on wait‐and‐watch and those treated with splenectomy or rituximab‐containing therapy. Over time, rituximab use and survival increased in patients ≥73 years. This is, to our knowledge, the largest population‐based study of splenic marginal zone lymphoma patients treated with upfront rituximab. We conclude that wait‐and‐watch remains the most reasonable option in asymptomatic splenic marginal zone lymphoma patients. Symptomatic patients should be offered single‐agent rituximab in first line.

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Asplenia and spleen hypofunction

Cited by 27 publications

References 198 publications

Long‐term haematological response and maintained immunological function after laparoscopic subtotal splenectomy in patients with hereditary spherocytosis

Long‐term haematological response and maintained immunological function after laparoscopic subtotal splenectomy in patients with hereditary spherocytosis

Specific Spleen‐Accumulated NIR‐II Fluorescent Probe for Imaging‐Guided Splenic Operation

Splenic marginal zone lymphoma in Sweden 2000–2020: Increasing rituximab use and better survival in the elderly

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