splenectomy?

[Larsonec]

anybody heard of removal of spleen for treatment of severe thrombocytopenia? A doc mentioned that to my father today as a possibility. My father is hospitalized with slightly enlarged liver and spleen. Platelets 6000, RBC=27. He is weak and short of breath most of the time.

[mscrzy1]

I've heard of it while reading about Evans syndrome which is an autoimmune disease in which your body destroys it's own blood cells (platelets, WBC, and RBC). Anytime there is an autoimmune response like in Evan's, the body shoots healthy cells to the spleen where they are destroyed. From what I understand, it is thought that if the spleen is removed, the body won't be able to destroy those cells. I believe that thrombocytopenia is similar to Evans in being an autoimmune disease destroying platelets, so I'm betting that your father's drs. are thinking the same type of treatment.

[Birgitta-A]

Hi Larsonec,
You know remiving the spleen is a dangerous operation. It is done in patients with for example Myelofibrosis when their spleen is very large. I have never read about this operation in MDS patients.
Kind regards
Birgitta-A

[mscrzy1]

Here is what Mayo clinic says about a splenectomy in regards to blood disorders:

Blood disorder. Severe cases of certain blood disorders, such as idiopathic thrombocytopenic purpura (ITP), polycythemia vera, thalessemia and sickle cell anemia may require splenectomy. But splenectomy is typically used only after other treatments have failed to reduce the symptoms of these disorders.

And here is what Mayo clinic has to say about its risks:

Splenectomy is generally a safe procedure. But as with any surgery, splenectomy carries the potential risk of complications. Potential complications include:

Bleeding
Blood clots
Infection
Injury to other organs nearby, including your stomach, pancreas and colon
Long-term risk of infection
After spleen removal, you're more likely to contract serious or even life-threatening infections. Following splenectomy, your doctor may recommend you receive a pneumonia vaccine and yearly flu vaccines. In some cases, preventive antibiotics may be recommended as well, especially if you have other conditions that increase your risk of serious infections.

http://www.mayoclinic.com/health/spl...N=why-its-done

http://http://www.mayoclinic.com/hea...DSECTION=risks

[mscrzy1]

Here is a great website for you to read about splenectomies for ITP. I've posted a few quotes from the website for you.

http://http://www.pdsa.org/itp-treat...lenectomy.html

Here's your answer as to hearing about splenectomy as a means of treatment for ITP:

Splenectomies have been used to treat ITP since 1913. The published success rates are about 60% for long term remission, although the measurement criteria for success and the definition of remission are not standardized in the studies. Splenectomized patients are at an increased risk for infections. As the time since splenectomy increases, the positive response to the procedure decreases.

Here is describing in scientific lingo what I was trying to explain about the spleen's function in autoimmune issues dealing with the blood, but specific to ITP.

ITP occurs when antibodies bind to platelets resulting in their clearance from circulation. In some instances, the antibodies may develop following an infection. Sometimes, antigen-antibody complexes adhere to platelets nonspecifically. In other cases, antiplatelet antibodies are autoantibodies. Why the antiplatelet antibodies develop is not entirely clear; however, some investigators have suggested that defects in T-cells may be involved. Alternatively, elimination of self-reactive B cells resulting in the production of autoantibodies may be involved. No matter what the mechanism, the close proximity of the B and T cells of the spleen to the circulating blood allows for exposure of platelet antigens to the immune system. This creates a continual immune response reaction resulting in the constant production of antiplatelet antibodies. These antibodies can attach to their platelet-specific antigens as the blood goes through the spleen and thus destroy the platelets. Therefore, the spleen fulfills a dual role in ITP: production of antiplatelet antibodies and removal of platelets from circulation.

[Larsonec]

interesting and thanks to all for replies. His docs expressed concern today that he may not be strong enough for splenectomy, but sounds like there is good history of using this procedure to treat ITP. I would think that trying a standard treatment like vidaza would be a better way to start. A doc I work with also wondered if they have ruled out paroxysmal nocturnal hemoglobinuria as my fathers bone marrow is hypocellular, where it is more usual to have hypercellular bone marrow in MDS, from what I understand. Not sure if that has been done, but will check...

[Birgitta-A]

Hi Larsonec,
As mscrzy1 wrote ITP is a totally different disease - these patients probably have normal bone marrow but their platelets are destoyed often in the spleen.

Patients with Myelofibrosis (also another disease but related to our disease) and very big spleens can have their spleen removed. As I wrote before I have ever read anything about splenectomy in MDS patients.

There are MDS patients with hypocellular bone marrow even if hypercellular - as you wrote - is more common. I have had hypocellular bone marrow since dx 2006 probably due to very severe bone marrow fibrosis.
Kind regards
Birgitta-A
73 yo, dx MDS Interm-1 2006. Tx dependent from dx - Sept 2010 when I had been treated with Thalidomide + Prednisone since June 2010.

[Linda Vuong]

Hi Larsonec.

I work for The MDS Beacon, a website for MDS patients and caregivers. We covered the possibility of splenectomy as an MDS treatment in this article:

http://www.mdsbeacon.com/news/2011/0...ents-ash-2010/