Efficacy and safety of splenectomy in adult autoimmune hemolytic anemia

Giudice, Valentina; Rosamilio, Rosa; Ferrara, Idalucia; Seneca, Elisa; Serio, Bianca; Selleri, Carmine

doi:10.1515/med-2016-0068

Cited by 10 publications

(5 citation statements)

References 46 publications

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“…Recommendation 26: Splenectomy should be used with caution for thrombocytopenia Splenectomy eliminates the site responsible for the production of autoantibodies and the destruction of red blood cells and platelets. It can be used to treat immune antibody-mediated thrombocytopenia refractory to conventional treatment, such as refractory ITP, TTP, and AIHA [89,142,195]. Splenectomy is indicated in patients whose course of disease is > 6 months and who do not respond to regular steroid treatment; patients who respond to steroid treatment but require high-dose maintenance therapy; and patients contraindicated for steroid therapy [89].…”

Section: Surgical Treatmentmentioning

confidence: 99%

Expert consensus on the diagnosis and treatment of thrombocytopenia in adult critical care patients in China

Song¹,

Liu

Zhu

et al. 2020

Military Med Res

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Thrombocytopenia is a common complication of critical care patients. The rates of bleeding events and mortality are also significantly increased in critical care patients with thrombocytopenia. Therefore, the Critical Care Medicine Committee of Chinese People's Liberation Army (PLA) worked with Chinese Society of Laboratory Medicine, Chinese Medical Association to develop this consensus to provide guidance for clinical practice. The consensus includes five sections and 27 items: the definition of thrombocytopenia, etiology and pathophysiology, diagnosis and differential diagnosis, treatment and prevention.

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Section: Surgical Treatmentmentioning

confidence: 99%

Expert consensus on the diagnosis and treatment of thrombocytopenia in adult critical care patients in China

Song¹,

Liu

Zhu

et al. 2020

Military Med Res

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“…Although splenectomy is far from being a new treatment for wAIHA, its position in the therapeutic armamentarium has changed. The response rates are high; probably 70-80% ( 8 , 107 ), but long-term data are sparser ( 108 ). Disadvantages are a risk of early or late bacterial infection, a further increased risk of thrombosis, and the irreversibility of the procedure ( 109 , 110 ).…”

Section: How To Select Therapy In Warm Aihamentioning

confidence: 99%

The choice of new treatments in autoimmune hemolytic anemia: how to pick from the basket?

2023

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Autoimmune hemolytic anemia (AIHA) is defined by increased erythrocyte turnover mediated by autoimmune mechanisms. While corticosteroids remain first-line therapy in most cases of warm-antibody AIHA, cold agglutinin disease is treated by targeting the underlying clonal B-cell proliferation or the classical complement activation pathway. Several new established or investigational drugs and treatment regimens have appeared during the last 1-2 decades, resulting in an improvement of therapy options but also raising challenges on how to select the best treatment in individual patients. In severe warm-antibody AIHA, there is evidence for the upfront addition of rituximab to prednisolone in the first line. Novel agents targeting B-cells, extravascular hemolysis, or removing IgG will offer further options in the acute and relapsed/refractory settings. In cold agglutinin disease, the development of complement inhibitors and B-cell targeting agents makes it possible to individualize therapy, based on the disease profile and patient characteristics. For most AIHAs, the optimal treatment remains to be found, and there is still a need for more evidence-based therapies. Therefore, prospective clinical trials should be encouraged.

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“…It is also noteworthy that, when analyzing the age at which splenectomy took place, the median age of patients with AIHA was significantly higher compared to the other indications given in these three previously mentioned studies. A comprehensive review of these studies on AIHA patients with a mean age above 55 years revealed that 94% of subjects (45 out of 48) underwent laparoscopic splenectomy with a complete response of 81% at 35.6 months, while the operative mortality was assessed at 0%, with no immediate or late thrombotic events [ 104 ]. Because of the high short-term efficacy and evidence of good long-term response, splenectomy was recommended as the most effective and best-evaluated second-line therapy for all steroid-refractory or steroid-dependent AIHA patients [ 105 ].…”

Section: The Place Of Splenectomy In the Era Of Novel Aiha Treatmentmentioning

confidence: 99%

The Role of the Spleen and the Place of Splenectomy in Autoimmune Hemolytic Anemia—A Review of Current Knowledge

Cvetković,

Pantić,

Cvetković

et al. 2023

Diagnostics

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Autoimmune hemolytic anemia (AIHA) is a rare, very heterogeneous, and sometimes life-threatening acquired hematologic disease characterized by increased red blood cell (RBC) destruction by autoantibodies (autoAbs), either with or without complement involvement. Recent studies have shown that the involvement of T- and B-cell dysregulation and an imbalance of T-helper 2 (Th2) and Th17 phenotypes play major roles in the pathogenesis of AIHA. AIHA can be primary (idiopathic) but is more often secondary, triggered by infections or drug use or as a part of other diseases. As the location of origin of autoAbs and the location of autoAb-mediated RBC clearance, as well as the location of extramedullary hematopoiesis, the spleen is crucially involved in all the steps of AIHA pathobiology. Splenectomy, which was the established second-line therapeutic option in corticosteroid-resistant AIHA patients for decades, has become less common due to increasing knowledge of immunopathogenesis and the introduction of targeted therapy. This article provides a comprehensive overview of current knowledge regarding the place of the spleen in the immunological background of AIHA and the rapidly growing spectrum of novel therapeutic approaches. Furthermore, this review emphasizes the still-existing expediency of laparoscopic splenectomy with appropriate perioperative thromboprophylaxis and the prevention of infection as a safe and reliable therapeutic option in the context of the limited availability of rituximab and other novel therapies.

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Efficacy and safety of splenectomy in adult autoimmune hemolytic anemia

Cited by 10 publications

References 46 publications

Expert consensus on the diagnosis and treatment of thrombocytopenia in adult critical care patients in China

Expert consensus on the diagnosis and treatment of thrombocytopenia in adult critical care patients in China

The choice of new treatments in autoimmune hemolytic anemia: how to pick from the basket?

The Role of the Spleen and the Place of Splenectomy in Autoimmune Hemolytic Anemia—A Review of Current Knowledge

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