Hemolytic anemia surgery: Difference between revisions
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==Surgery== | ==Surgery== | ||
'''[[Splenectomy]] is a second-line therapy option and is typically done only if there is non-response to steroids. The response rate to splenectomy is usually 60-70%. Splenectomy is ideal for patients with extravascular hemolysis and Fc receptor mediated hemolysis, since the spleen in involved in the pathophysiology of these aspects of hemolytic anemia.<ref name="pmid26696797">{{cite journal| author=Salama A| title=Treatment Options for Primary Autoimmune Hemolytic Anemia: A Short Comprehensive Review. | journal=Transfus Med Hemother | year= 2015 | volume= 42 | issue= 5 | pages= 294-301 | pmid=26696797 | doi=10.1159/000438731 | pmc=4678315 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26696797 }} </ref> | |||
*Adverse effects: Given that this is a surgery, the risks and benefits must be carefully weighed, as surgical interventions typically have higher risks than medication interventions. Splenectomy carries an inherent surgical risk in addition to the risk for infections from encapsulated organisms, such as Neisseria meningitides, Streptococcus pneumoniae, and Hemophilus influenzae. Patients who plan to undergo splenectomy should be vaccinated prior to the surgery. In the current era, the surgical risk of splenectomy is likely lower than in the prior decades, as laparoscopic and minimally invasive approaches are used. Thrombosis is another risk of splenoectomy.<ref name="pmid26696797">{{cite journal| author=Salama A| title=Treatment Options for Primary Autoimmune Hemolytic Anemia: A Short Comprehensive Review. | journal=Transfus Med Hemother | year= 2015 | volume= 42 | issue= 5 | pages= 294-301 | pmid=26696797 | doi=10.1159/000438731 | pmc=4678315 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26696797 }} </ref> | |||
In some cases of extravascular hemolysis, [[splenectomy]] can be helpful. In this case, most of the red blood cells are being destroyed by the spleen, and surgical removal of the spleen can correct the underlying problem. Splenectomy can help the hemoglobin level to return towards baseline. The risks and benefits of splenoectomy should be weighed prior to proceeding with splenectomy. There is a high risk for asplenic sepsis with encapsulated organisms, such as Neisseria, Hemophilius, and Streptococcus.<ref name="pmid26543526">{{cite journal| author=Leone G, Pizzigallo E| title=Bacterial Infections Following Splenectomy for Malignant and Nonmalignant Hematologic Diseases. | journal=Mediterr J Hematol Infect Dis | year= 2015 | volume= 7 | issue= 1 | pages= e2015057 | pmid=26543526 | doi=10.4084/MJHID.2015.057 | pmc=4621170 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26543526 }} </ref> Patients should be vaccinated against these organisms prior to spleen removal. | In some cases of extravascular hemolysis, [[splenectomy]] can be helpful. In this case, most of the red blood cells are being destroyed by the spleen, and surgical removal of the spleen can correct the underlying problem. Splenectomy can help the hemoglobin level to return towards baseline. The risks and benefits of splenoectomy should be weighed prior to proceeding with splenectomy. There is a high risk for asplenic sepsis with encapsulated organisms, such as Neisseria, Hemophilius, and Streptococcus.<ref name="pmid26543526">{{cite journal| author=Leone G, Pizzigallo E| title=Bacterial Infections Following Splenectomy for Malignant and Nonmalignant Hematologic Diseases. | journal=Mediterr J Hematol Infect Dis | year= 2015 | volume= 7 | issue= 1 | pages= e2015057 | pmid=26543526 | doi=10.4084/MJHID.2015.057 | pmc=4621170 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26543526 }} </ref> Patients should be vaccinated against these organisms prior to spleen removal. | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Shyam Patel [2]
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Overview
Surgery
Splenectomy is a second-line therapy option and is typically done only if there is non-response to steroids. The response rate to splenectomy is usually 60-70%. Splenectomy is ideal for patients with extravascular hemolysis and Fc receptor mediated hemolysis, since the spleen in involved in the pathophysiology of these aspects of hemolytic anemia.[1]
- Adverse effects: Given that this is a surgery, the risks and benefits must be carefully weighed, as surgical interventions typically have higher risks than medication interventions. Splenectomy carries an inherent surgical risk in addition to the risk for infections from encapsulated organisms, such as Neisseria meningitides, Streptococcus pneumoniae, and Hemophilus influenzae. Patients who plan to undergo splenectomy should be vaccinated prior to the surgery. In the current era, the surgical risk of splenectomy is likely lower than in the prior decades, as laparoscopic and minimally invasive approaches are used. Thrombosis is another risk of splenoectomy.[1]
In some cases of extravascular hemolysis, splenectomy can be helpful. In this case, most of the red blood cells are being destroyed by the spleen, and surgical removal of the spleen can correct the underlying problem. Splenectomy can help the hemoglobin level to return towards baseline. The risks and benefits of splenoectomy should be weighed prior to proceeding with splenectomy. There is a high risk for asplenic sepsis with encapsulated organisms, such as Neisseria, Hemophilius, and Streptococcus.[2] Patients should be vaccinated against these organisms prior to spleen removal.
References
- ↑ 1.0 1.1 Salama A (2015). "Treatment Options for Primary Autoimmune Hemolytic Anemia: A Short Comprehensive Review". Transfus Med Hemother. 42 (5): 294–301. doi:10.1159/000438731. PMC 4678315. PMID 26696797.
- ↑ Leone G, Pizzigallo E (2015). "Bacterial Infections Following Splenectomy for Malignant and Nonmalignant Hematologic Diseases". Mediterr J Hematol Infect Dis. 7 (1): e2015057. doi:10.4084/MJHID.2015.057. PMC 4621170. PMID 26543526.