Splenectomy Health Article

Definition

Splenectomy is the surgical removal of the spleen, which is an organ that is part of the lymphatic system. The spleen is a dark purple, bean-shaped organ located in the upper left side of the abdomen, just behind the bottom of the rib cage. In adults, the spleen is about 4.8 2.8 1.6 in in size, and weighs about 4 or 5 oz. (It measures 12 7 4 cm, and weighs between 113 and 141 grams.) Its functions include: playing a role in the immune system, filtering foreign substances from the blood, removing worn-out blood cells from the blood, regulating blood flow to the liver, and sometimes storing blood cells. The storage of blood cells is called sequestration. In healthy adults, about 30% of blood platelets are sequestered in the spleen.

Purpose

Splenectomies are performed for a variety of different reasons and with different degrees of urgency. Most splenectomies are done after the patient has been diagnosed with hypersplenism. Hypersplenism is not a specific disease but a group of symptoms, or a syndrome, that can be produced by a number of different disorders. Hypersplenism is characterized by enlargement of the spleen (splenomegaly), defects in the blood cells, and an abnormally high turnover of blood cells. It is almost always associated with splenomegaly caused by specific disorders such as cirrhosis of the liver or certain cancers, such as leukemia or lymphomas (both Hodgkin's and non-Hodgkin's). Because serious consequences may result from removal of immune system organs such as the spleen, the decision to perform a splenectomy depends on the severity and prognosis of the disease or condition causing the hypersplenism.

Splenectomy always necessary

There are two diseases for which splenectomy is the only treatment—primary cancers of the spleen and a blood disorder called hereditary spherocytosis (HS). In HS, the absence of a specific protein in the red blood cell membrane leads to the formation of relatively fragile cells that are easily damaged when they pass through the spleen. The cell destruction does not occur elsewhere in the body and ends when the spleen is removed. HS can appear at any age, even in newborns, although doctors prefer to put off removing the spleen until the child is five or six years old.

Splenectomy usually necessary

There are some disorders in which splenectomy is usually recommended. They include:

• Immune (idiopathic) thrombocytopenic purpura (ITP). ITP is a disease involving platelet destruction. Splenectomy is the definitive treatment for this disease and is effective in about 70% of chronic ITP cases.
• Trauma. The spleen can be ruptured by blunt as well as penetrating injuries to the chest or abdomen. Car accidents are the most common cause of blunt traumatic injury to the spleen. Occasionally, the spleen is injured during an operation within the abdomen. Sometimes, the spleen can be repaired (splenorrhaphy) rather than removed.
• Abscesses in the spleen. These are relatively uncommon but have a high mortality rate.
• Rupture of the splenic artery. Rupture sometimes occurs as a complication of pregnancy.
• Hereditary elliptocytosis. This is a relatively rare disorder. It is similar to HS in that it is characterized by red blood cells with defective membranes that are destroyed by the spleen.

Due to more sophisticated imaging techniques, non-operative splenic preservation is becoming more common for injuries due to splenic trauma. Splenectomy should be avoided whenever possible as the advantages of splenic preservation have been well established. Specifically, splenectomy increases the risks of postoperative and long-term infection, and the procedure is associated with excessive transfusion requirements.

Splenectomy sometimes necessary

In other disorders, the spleen may or may not be removed.

• Hodgkin's disease, a serious form of cancer that causes lymph nodes to enlarge and causes the immune system to malfunction. Treatments such as radiation, chemotherapy, and surgical removal of the spleen can exacerbate this malfunction, increasing the likelihood of infection. Splenectomy is sometimes performed in order to find out how far the disease has progressed. However, splenectomy has been shown to increase the risk of secondary acute leukemia in patients with Hodgkin's disease.
• Hairy cell leukemia. Patients may suffer discomfort due to a very enlarged spleen caused by leukemia cells growing in the spleen. Splenectomy was once the only treatment for this disease; but due to the complications associated with splenectomy (low blood cell counts, fatigue, frequent infections, and easy bleeding or bruising), physicians are now more often recommending chemotherapy.
• Chronic myeloid disorders. These disorders include chronic myelocytic leukemia, polycythemia vera, essential thrombocythemia, and agnogenic myeloid metaplasia (myelofibrosis); they enlarge the spleen to various degrees. In early stages of chronic myelocytic leukemia, splenectomy does not provide much benefit.
• Myelofibrosis. Myelofibrosis is a disorder in which bone marrow is replaced by fibrous tissue. It produces severe and painful splenomegaly. Splenectomy does not cure myelofibrosis but may be performed to relieve pain caused by the swollen spleen.
• Thrombotic thrombocytopenic purpura (TTP). TTP is a rare disorder marked by fever, kidney failure, and an abnormal decrease in the number of platelets. Splenectomy is one part of treatment for TTP.
• Autoimmune hemolytic disorders. These disorders may appear in patients of any age but are most common in patients over 50. The red blood cells are destroyed by antibodies produced by the patient's own body (autoantibodies).
• Thalassemia. Thalassemia is a hereditary form of anemia that is most common in people of Mediterranean origin. Splenectomy is sometimes performed if the patient's spleen has become painfully enlarged.