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Clinical and surgical outcomes of splenectomy for autoimmune hemolytic anemia

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Abstract

Introduction

We investigated short and long-term remission rates after splenectomy in patients with primary and secondary autoimmune hemolytic anemia (AIHA).

Methods

All adults who underwent splenectomy for primary or secondary AIHA at a single center (2004–2018) were retrospectively reviewed. Short-term response was determined at 30-day postoperatively and long-term at one year. Complete response was defined as hemoglobin > 10 g/dL without hemolysis, transfusions, or need for additional medical therapy for > 6 months.

Results

Short-term complete response was attained in 22 of 36 patients (61%), partial response in 3 (8%), no response in 11 (31%). The response rate at 1 year was complete in 14/36 (39%), partial in 14 (39%), and 8 non-response (22%). At last available follow-up (median 33.1 months (IQR 19–59), 16/37 patients had experienced a complete response (43%), 14 partial response (38%), 7 non-response (19%). 80% of partial responders with primary AIHA required maintenance therapy compared to 100% with secondary AIHA.

Conclusion

Splenectomy is associated with short- and long-term improvement in anemia and hemolysis in the majority of patients with AIHA. Immunosuppressants remain important supplemental therapy.

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Authors and Affiliations

  1. General Surgery, Cleveland Clinic, Cleveland, OH, USA

    Sara Maskal, Raha Al Marzooqi, Aldo Fafaj, Samuel Zolin, Robert Naples, Advait Iyer, Clayton Petro, David Krpata, Ajita Prabhu, Michael Rosen & Steven Rosenblatt

  2. Department of General Surgery, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA

    Sara Maskal

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  1. Sara Maskal
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Contributions

(I) Conception and design: RAM, SM, SR; (II) Administrative support: None; (III) Provision of study materials or patients: SR, MR; (IV) Collection and assembly of data: SM; RAM, SZ, AF; (V) Data analysis and interpretation: SM, AF, RN, SZ, CP, MR, SR; (VI) Manuscript writing: SM, AF, AI, DK, AP, CP, MR, SR; (VII) Final approval of manuscript: All authors.

Corresponding author

Correspondence to Sara Maskal.

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Disclosures

Ajita Prabhu MD reports personal fees from Verb Surgical, personal fees from CMR Surgical, grants and personal fees from Intuitive Surgical, outside the submitted work. Michael Rosen MD reports personal fees from ACHQC, outside the submitted work. Aldo Fafaj MD, reports grants from AHSQC, outside the submitted work. Sara Maskal MD, Raha Al Marzooqi MD, Samuel Zolin MD, Robert Naples DO, Advait Iyer DO, Clayton Petro MD, David Krpata MD, Steven Rosenblatt MD have no conflicts of interest or financial ties to disclose.

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Maskal, S., Al Marzooqi, R., Fafaj, A. et al. Clinical and surgical outcomes of splenectomy for autoimmune hemolytic anemia. Surg Endosc 36, 5863–5872 (2022). https://doi.org/10.1007/s00464-022-09116-x

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  • DOI: https://doi.org/10.1007/s00464-022-09116-x

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