Autoimmune hemolytic anemia surgery: Difference between revisions
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==Surgery== | ==Surgery== | ||
===Splenectomy=== | ===Splenectomy=== | ||
[[Splenectomy]], or removal of the spleen, is a second-line option for autoimmune hemolytic anemia. Splenectomy is frequently considered for patients who have steroid-refractory or relapsed disease. The response rate for splenectomy is typically 66%, and nearly 20% of patients will experience a cure.<ref name="pmid25271314">{{cite journal| author=Zanella A, Barcellini W| title=Treatment of autoimmune hemolytic anemias. | journal=Haematologica | year= 2014 | volume= 99 | issue= 10 | pages= 1547-54 | pmid=25271314 | doi=10.3324/haematol.2014.114561 | pmc=4181250 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25271314 }} </ref> The ideal candidate for splenectomy is one who has adequate functional status and cardiopulmonary reserve to undergo surgery. The decision to proceed with splenectomy is typically made jointly between the patient and physician, as surgical intervention carries inherent risks. Given the infectious risk for splenectomy, patients should undergo vaccination for ''Hemophilus influenzae'', ''Neisseria meningitides'', and ''Streptococcus pneumoniae.'' The three organisms are encapsulated bacteria which are normally eliminated by the spleen via complement-mediated opsonization. | [[Splenectomy]], or removal of the spleen, is a second-line option for autoimmune hemolytic anemia. Splenectomy is frequently considered for patients who have steroid-refractory or relapsed disease. The response rate for splenectomy is typically 66%, and nearly 20% of patients will experience a cure.<ref name="pmid25271314">{{cite journal| author=Zanella A, Barcellini W| title=Treatment of autoimmune hemolytic anemias. | journal=Haematologica | year= 2014 | volume= 99 | issue= 10 | pages= 1547-54 | pmid=25271314 | doi=10.3324/haematol.2014.114561 | pmc=4181250 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25271314 }} </ref> Splenectomy is considered for patients requiring a daily prednisone dose of 10mg or greater or having multiple relapses. Splenectomy can also reduce the dose of steroids required to maintain control of the disease. The ideal candidate for splenectomy is one who has adequate functional status and cardiopulmonary reserve to undergo surgery. The decision to proceed with splenectomy is typically made jointly between the patient and physician, as surgical intervention carries inherent risks. Given the infectious risk for splenectomy, patients should undergo vaccination for ''Hemophilus influenzae'', ''Neisseria meningitides'', and ''Streptococcus pneumoniae.'' The three organisms are encapsulated bacteria which are normally eliminated by the spleen via complement-mediated opsonization. | ||
*''Adverse effects'': The adverse effects of splenectomy include the inherent surgical risk, bleeding, post-operative thrombosis, post-operative pain, systemic infection (asplenic sepsis) with encapsulated organisms, and reactive thrombocytosis. | *''Adverse effects'': The adverse effects of splenectomy include the inherent surgical risk, bleeding, abdominal wall abscess, hematoma, post-operative thrombosis including pulmonary embolism, post-operative pain, systemic infection (asplenic sepsis) with encapsulated organisms, and reactive thrombocytosis. The risk of sepsis is 3.3-5%. The mortality rate of asplenic sepsis is 50%. The inherent surgical risk of open splenectomy can be reduced by performing laparoscopic splenectomy. | ||
==References== | ==References== | ||
Revision as of 01:44, 18 March 2018
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Autoimmune hemolytic anemia Microchapters |
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Differentiating Autoimmune hemolytic anemia from other Diseases |
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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
Splenectomy, or removal of the spleen, is a second-line option for autoimmune hemolytic anemia. Splenectomy is frequently considered for patients who have steroid-refractory or relapsed disease. The response rate for splenectomy is typically 66%, and nearly 20% of patients will experience a cure.[1] Splenectomy is considered for patients requiring a daily prednisone dose of 10mg or greater or having multiple relapses. Splenectomy can also reduce the dose of steroids required to maintain control of the disease. The ideal candidate for splenectomy is one who has adequate functional status and cardiopulmonary reserve to undergo surgery. The decision to proceed with splenectomy is typically made jointly between the patient and physician, as surgical intervention carries inherent risks. Given the infectious risk for splenectomy, patients should undergo vaccination for Hemophilus influenzae, Neisseria meningitides, and Streptococcus pneumoniae. The three organisms are encapsulated bacteria which are normally eliminated by the spleen via complement-mediated opsonization.
- Adverse effects: The adverse effects of splenectomy include the inherent surgical risk, bleeding, abdominal wall abscess, hematoma, post-operative thrombosis including pulmonary embolism, post-operative pain, systemic infection (asplenic sepsis) with encapsulated organisms, and reactive thrombocytosis. The risk of sepsis is 3.3-5%. The mortality rate of asplenic sepsis is 50%. The inherent surgical risk of open splenectomy can be reduced by performing laparoscopic splenectomy.
References
- ↑ Zanella A, Barcellini W (2014). "Treatment of autoimmune hemolytic anemias". Haematologica. 99 (10): 1547–54. doi:10.3324/haematol.2014.114561. PMC 4181250. PMID 25271314.