Hemolytic anemia surgery: Difference between revisions
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==Overview== | ==Overview== | ||
Splenectomy is a surgical option for hemolytic anemia. Importantly, there are many risks with splenectomy. These risks must be weighed against the potential benefits. | [[Splenectomy]] is a surgical option for hemolytic anemia. Importantly, there are many risks with splenectomy. These risks must be weighed against the potential benefits. | ||
==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> | '''[[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 [[Hemolysis|extravascular hemolysis]] and [[Fc receptor]] mediated hemolysis, since [[Spleen|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. | *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. | ||
**Surgical risk: Splenectomy carries an inherent surgical risk. These include alterations in cardiorespiratory status given that general anesthesia must be administered and intubation with mechanical ventilation is usually done. | **Surgical risk: Splenectomy carries an inherent surgical risk. These include alterations in cardiorespiratory status given that [[general anesthesia]] must be administered and [[intubation]] with [[mechanical ventilation]] is usually done. | ||
**Infections: Splenectomy can be complicated by infections from encapsulated organisms, such as Neisseria meningitides, Streptococcus pneumoniae, and Hemophilus influenzae.<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 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. Pre-splenectomy vaccinations should be given at least 14 days prior to splenectomy: | **[[Infections]]: [[Splenectomy]] can be complicated by infections from [[encapsulated organisms]], such as [[Neisseria meningitidis|Neisseria meningitides]], [[Streptococcus pneumoniae]], and [[Haemophilus influenzae|Hemophilus influenzae]].<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 who plan to undergo splenectomy should be [[vaccinated]] prior to the [[surgery]]. In the current era, the [[Surgical risk assessment|surgical risk]] of [[splenectomy]] is likely lower than in the prior decades, as [[laparoscopic]] and minimally invasive approaches are used. Pre-splenectomy [[vaccinations]] should be given at least 14 days prior to [[splenectomy]]: | ||
***Give PCV13, wait at least 8 weeks, then give PPSV23 | ***Give PCV13, wait at least 8 weeks, then give PPSV23 | ||
***Give 2 doses of Menactra or Menveo 2 months apart | ***Give 2 doses of [[Menactra]] or Menveo 2 months apart | ||
***Give either Trumenba (3 doses administered at 0, 1 to 2, and 6 months) or Bexsero (2 doses administered at least one month apart) | ***Give either Trumenba (3 doses administered at 0, 1 to 2, and 6 months) or Bexsero (2 doses administered at least one month apart) | ||
***Revaccination with PPSV every 5 years | ***Revaccination with PPSV every 5 years | ||
***Revaccinate with either Menactra or Menveo booster every 5 years | ***Revaccinate with either Menactra or Menveo booster every 5 years | ||
**Thrombosis: Clot formation is another risk of splenectomy.<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> | **[[Thrombosis]]: [[Clot]] formation is another risk of [[splenectomy]].<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> | ||
==References== | ==References== | ||
Latest revision as of 19:21, 31 October 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Shyam Patel [2]
Overview
Splenectomy is a surgical option for hemolytic anemia. Importantly, there are many risks with splenectomy. These risks must be weighed against the potential benefits.
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.
- Surgical risk: Splenectomy carries an inherent surgical risk. These include alterations in cardiorespiratory status given that general anesthesia must be administered and intubation with mechanical ventilation is usually done.
- Infections: Splenectomy can be complicated by infections from encapsulated organisms, such as Neisseria meningitides, Streptococcus pneumoniae, and Hemophilus influenzae.[2] 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. Pre-splenectomy vaccinations should be given at least 14 days prior to splenectomy:
- Give PCV13, wait at least 8 weeks, then give PPSV23
- Give 2 doses of Menactra or Menveo 2 months apart
- Give either Trumenba (3 doses administered at 0, 1 to 2, and 6 months) or Bexsero (2 doses administered at least one month apart)
- Revaccination with PPSV every 5 years
- Revaccinate with either Menactra or Menveo booster every 5 years
- Thrombosis: Clot formation is another risk of splenectomy.[1]
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.